tb travel policy

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Tuberculosis and Air Travel: Guidelines for Prevention and Control. 3rd edition. Geneva: World Health Organization; 2008.

Tuberculosis and Air Travel: Guidelines for Prevention and Control. 3rd edition.

10 recommendations.

While the following recommendations are provided for guidance and are not legally binding upon States, it is important to note that depending on the particular national context, the same subjects or issues may also be covered by national or international laws or regulations which are legally binding.

In addition, these recommendations should be distinguished from official “temporary recommendations” during a public health emergency of international concern or “standing recommendations” for routine application which may be issued under the International Health Regulations (2005) as noted in Annex 1 . Such IHR recommendations have particular legal consequences as indicated in the Regulations, and are adopted and issued according to specified procedures.

• For travellers

People with infectious or potentially infectious TB should postpone all travel by commercial air transportation 1 of any flight duration until they become non-infectious.

• For physicians

Physicians should inform all infectious and potentially infectious TB patients that they must not travel by air on any commercial flight of any duration until they are sputum smear-negative on at least two occasions (additional steps are required for MDR-TB and XDR-TB, see recommendation 3).

Physicians should inform all MDR-TB and XDR-TB patients that they must not travel by any commercial flight – under any circumstances or on a flight of any duration – until they are proven to be non-infectious (i.e. two consecutive negative sputum-culture results).

Physicians should immediately inform the relevant public health authority when they are aware that an infectious or potentially infectious TB patient intends to travel against medical advice.

Physicians should immediately inform the relevant public health authority when they are aware that an infectious or potentially infectious TB patient may have exceptional circumstances requiring commercial air travel.

Post-travel

Physicians should immediately inform the public health authority when an infectious or potentially infectious TB patient has a history of commercial air travel within the previous three months.

• For public health authorities (see also requirements under the IHR)

Public health authorities aware that a person with infectious or potentially infectious TB is planning to travel via a commercial air carrier should inform the concerned airline and request that boarding be denied.

If an infectious or potentially infectious TB patient has exceptional circumstances that may require commercial air travel, public health authorities should ensure that the airline(s) involved and the national public health authorities at departure, arrival and any transit points have approved the commercial air travel and the procedures for travel.

The public health authority (see section 6.1 ) should promptly contact the airline when an infectious or potentially infectious TB patient is known to have travelled on a commercial flight that may have been of 8 hours duration or longer within the preceding three months in order to obtain the information required for the initial risk assessment (i.e. confirm that the passenger was on the flight and the total flight duration).

The public health authority of the country of diagnosis should carry out a risk assessment based on the specific conditions of the case. If the index case is considered to be infectious or potentially infectious, the public health authorities of all countries involved should be informed (i.e. all countries where the flight(s) departed and landed).

If a contact investigation involves more than one country, national public health authorities of the involved countries should agree on their respective roles and responsibilities (including who will request the passenger manifests from airlines). International bodies such as WHO, the EC, ECDC or others may provide assistance if requested.

The national public health authority that obtained the passenger information from the airline should contact counterpart public health authorities in the appropriate countries and provide them with the relevant information on the source case and the available contact information of all travellers identified as potentially exposed (i.e. those passengers seated in the same row and in the two rows in front of and behind the index case) in their jurisdiction. (See chapter 7 on legal confidentiality and permitted dissemination of such information.)

Public health authorities may follow national policies and guidelines regarding TB contact investigation involving potentially exposed travellers in their jurisdiction (see also Annex 3 for a suggested approach), in accordance with requirements under the IHR.

Public health authorities should be in communication with their national IHR focal point concerning any event that may involve the IHR, including events for which international contact-tracing may be initiated, for assessment of any action that may be required under the IHR and support in facilitating communication.

National and international public health authorities are encouraged to collaborate on a TB and air travel research agenda.

• For airline companies

Airline companies should deny boarding to any person who is known to have infectious or potentially infectious TB as informed by the relevant public health authority.

Airline companies should, in the case of ground delays that last for 30 minutes or longer with passengers on board, ensure that the ventilation system is in operation.

Airline companies should ensure that all their aircraft which recirculate the cabin air are fitted with a filtration system. New aircraft should be fitted with 99.97% efficiency HEPA filters, or an alternative of at least this level of efficiency. The filtration system should be maintained in accordance with the recommendations of the filter manufacturer.

Airline companies should ensure that cabin crew receive adequate training on potential exposure to communicable diseases, in first aid, and in applying universal precautions when there may be exposure to body fluids.

Airline companies should ensure that there are adequate emergency medical supplies aboard all aircraft (including gloves, surgical masks, biohazard disposal bags and disinfectant).

Airline companies should cooperate with national public health authorities in providing as quickly as possible all available contact information requested for contact-tracing of travellers, in accordance with applicable legal requirements including the IHR (see Annex 1 ).

Excluding specially-designated aircraft – air ambulance.

All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob ). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: tni.ohw@snoissimrep ).

• Cite this Page Tuberculosis and Air Travel: Guidelines for Prevention and Control. 3rd edition. Geneva: World Health Organization; 2008. 10, Recommendations.
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Tuberculosis Information for International Travelers

This information sheet discusses TB and the risk for international travelers. It explains TB transmission, multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of the disease, and how drug resistance occurs. The information sheet considers whether international travelers are at risk of MDR or XDR TB while traveling, the risk of acquiring TB on an airplane, how TB can be prevented, TB vaccine, and what an individual should do before traveling internationally and if an individual thinks that he/she may have been exposed to someone with TB disease. It lists the symptoms of TB disease and where to find other health information about a travel destination. Contact information is provided for additional resources.

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Travel Directive

Note:   Public Service employees must contact their  Designated Departmental Travel Coordinator  with their questions.

Communiqués                      Other related documents

• Collective agreement
• Grievance procedure
• Effective date
• Purpose and scope
• Application
• Definitions
• 1.1 Authorization
• 1.2 Loyalty programs
• 1.3 Overpayments                       
• 1.4 Receipts
• 1.5 Responsibilities
• 1.6 Suppliers, services and products
• 1.7 Travel advances
• 1.8 Travel forms
• 1.9 Workplace change (applies within the headquarters area only)
• 2.1 Insurance plans and compensation
• 2.2.1 Crown Vehicles
• 2.2.2 Rental Vehicles
• 2.2.3 Private Motor Vehicles
• 3.1.1 Accommodation
• 3.1.2 Additional business expenses
• 3.1.3 Bottled water
• 3.1.4 Currency exchange
• 3.1.5 Dependant care
• 3.1.6 Home communication
• 3.1.7 Incidental expense allowance
• 3.1.8 Insurance
• 3.1.9 Meals
• 3.1.10 Rest periods
• 3.1.11 Transportation
• 3.1.12 Weekend travel home
• 3.1.13 Weekend travel - alternatives
• 3.2.1 Accommodation
• 3.2.2 Additional business expenses
• 3.2.3 Bottled water
• 3.2.4 Currency exchange
• 3.2.5 Dependant care
• 3.2.6 Home communication
• 3.2.7 Incidental expense allowance
• 3.2.8 Insurance
• 3.2.9 Meals
• 3.2.10 Rest periods
• 3.2.11 Transportation
• 3.2.12 Weekend travel home
• 3.2.13 Weekend travel - alternatives
• 3.3.1 Accommodation
• 3.3.2 Additional business expenses
• 3.3.3 Bottled water
• 3.3.4 Currency exchange
• 3.3.5 Dependant care
• 3.3.6 Home communication
• 3.3.7 Incidental expense allowance
• 3.3.8 Insurance
• 3.3.9 Meals
• 3.3.10 Rest periods
• 3.3.11 Transportation
• 3.3.12 Weekend travel home
• 3.3.13 Weekend travel - alternatives
• 3.4.1 Accommodation
• 3.4.2 Additional business expenses
• 3.4.3 Bottled water
• 3.4.4 Currency exchange
• 3.4.5 Dependant care
• 3.4.6 Home communication
• 3.4.7 Incidental expense allowance
• 3.4.8 Insurance
• 3.4.9 Meals
• 3.4.10 Rest periods
• 3.4.11 Transportation
• 3.4.12 Weekend travel home
• 3.4.13 Weekend travel - alternatives
• 4.1 Escort Officers
• 4.2 Ships Officers / Ships Crews
• 4.3 Special transportation needs
• 5.1 Death while in travel status
• 5.2 Emergencies, illnesses and injuries while in travel status
• Appendix A - Guide to Insurance Coverage for Employees on government Travel
• Appendix B - Kilometric Rates - Modules 1, 2 and 3
• Appendix C - Allowances - Modules 1, 2 and 3
• Appendix D - Allowances - Module 4
• Appendix E - Blanket travel authority templates - Module 1 - Travel within headquarters area
• Appendix E - Module 2 - Travel outside headquarters area - no overnight stay
• Appendix E - Module 3 - Travel in Canada and continental U.S.A. - overnight stay
• Appendix E - Module 4 - International travel - overnight stay
• Appendix F - Sample declaration

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Directive on Travel

Version number: 2.17

Version date: April 1, 2024

Upon request, this corporate policy instrument (CPI) is available in multiple formats for individuals with a visual impairment (email Multiple Media-PAB (CRA) ).

Table of contents

• Effective date
• Application
• Related corporate policy instruments
• Objectives and outcomes
• Requirements
• Roles and responsibilities
• Review and assessment
• Version history
• Definitions

1. Effective date

The Directive on Travel received Board of Management (Board) approval and came into effect on June 16, 2020 (Board Resolution #2020-2021-06).

This directive replaces the 2013 Travel Directive and the 2006 Travel Loyalty Programs Policy.

For the version history of this document, see  section 11 .

2. Application

The directive applies to employees and other persons travelling on Canada Revenue Agency (CRA) business, such as Members of Parliament, the Minister’s exempt staff and contractors, and is mandatory to follow. It does not apply to those persons whose travel is governed by other authorities, such as the Minister.

The term "employees" has been deliberately used throughout the directive to distinguish entitlements that apply to strictly employees. Sections pertaining to "travellers" apply to contractors and other persons travelling on CRA business. For the purposes of this directive, the term employee will encompass members of the Board.

The Code of Integrity and Professional Conduct highlights the rules, and describes the values, that guide CRA employees in their work. The Code, along with the CRA Foundation Framework for Corporate Policy, sets out the requirement to follow CPIs.

Consequences of non-compliance for employees: failure to comply with CPIs may result in corrective measures, including administrative and disciplinary action.

To help interpret and implement this directive, key terms are defined in the Definitions section.

3. Related corporate policy instruments

This directive flows from the Policy on Financial Management and Financial Administration.

This directive should be read in conjunction with the Directive on Pre-approval of Travel, Hospitality, Conferences and Event Expenditures.

For any other related CPIs, see References .

4. Overview

This directive sets out the financial administration requirements for the reimbursement of reasonable expenses necessarily incurred by travellers on CRA business.

The kilometric rates and meal allowances set out in this directive are those guided and established by the National Joint Council (NJC). While this directive is guided by the NJC, the entitlements of the employees will be determined in accordance with the provisions of this directive.

The Canada Revenue Agency Act  (CRA Act) provides the authority for the CRA to set its own policy instruments for certain financial administration activities. These activities are listed in the Policy on Financial Management and Financial Administration in Appendix A: CRA specific activities under financial administration. This authority is reflected in this directive.

Travel entitlements under the requirements of the Directive on Relocation are not covered under this directive.

Executive groups, the Board of Management members, the Commissioner and Deputy Commissioner are provided special travel authorities guided by Treasury Board's Special Travel Authorities  as per Order-In-Council (number P.C. 1997-1810).

Headquarters area, as referred to in this directive, pertains to the area surrounding the traveller's workplace having a perimeter that is at a distance of 16 km from the workplace, measured by the most direct, safe and practical road route.

5. Objectives and outcomes

5.1 objectives.

5.1.1 - To ensure fair and consistent treatment of employees and other persons travelling on CRA business to fulfill the CRA's mandate.

5.1.2 - To ensure the entitlements of the travellers do not constitute income or other compensation that would open the way for personal gain.

5.2 Outcomes

5.2.1 - Effective governance and oversight over the financial administration of travel entitlements.

5.2.2 - The CRA travel expenditures are managed efficiently and effectively in a fashion that will withstand audit and public scrutiny.

5.2.3 - The most economical, environmental and practical travel arrangements are selected.

6. Requirements

6.1 authorization.

6.1.1 All CRA travel must be pre-approved as per the requirements of the Directive on Pre-approval of Travel, Hospitality, Conferences and Events.

6.1.2 All travel is approved in accordance with the Delegation of Spending and Financial Authorities Matrix for Agency Activities.

6.1.3 Sustainable travel options should be considered during the pre-authorization of travel arrangements.

6.1.4 Travellers will not be paid for travel expenses related to travel for personal reasons.

6.2 Travel advances

6.2.1 A provision of an advance is provided to cover travel expenses where government approved services or products are not prepaid or when an employee on CRA business travel chooses not to use a Designated Travel Card (DTC).

6.2.2 Employees will be provided with a travel advance only if all overdue advances have been accounted for.

6.2.3 Contractors are not entitled to travel advances.

6.3 Workplace change

6.3.1 When there is a permanent workplace change such as displacement resulting from a staffing action, the employee is not entitled to travel expenses between the residence and the new workplace.

6.3.2 When an employee is asked to report from a permanent workplace to a temporary workplace for a period of less than 30 consecutive calendar days, the requirements of this directive shall apply.

6.3.3 When an employee is assigned from a permanent workplace to a temporary workplace for a period of 30 consecutive calendar days or more, the CRA is to notify the employee in writing in advance of the temporary workplace change. This written notice cannot be backdated.

• 6.3.3.1 The requirements of this directive will not apply if the employee is notified in writing 30 calendar days or more in advance of the temporary workplace change.
• 6.3.3.2 If the employee is notified in writing for a period of 29 calendar days or less prior to the start date at the temporary workplace or 30 calendar days or less after the start date at the temporary workplace, the requirements of this directive will apply from the start date at the temporary workplace up to a maximum of 30 calendar days following the date of the written notice.
• 6.3.3.3 In the event the employee is not notified of the temporary workplace change in writing within the first 30 calendar days following the start date at the temporary workplace, the requirements of this directive will apply up to a maximum of 60 calendar days following the start date at the temporary workplace.

6.4 Virtual work

6.4.1 Employees who are authorized to telework, working remotely from another CRA establishment or field work, whereby a virtual work agreement has been duly signed, the building to which they report remains their workplace.

6.4.2 When required to travel to a location other than their workplace and conditions in the CRA Policy on Workplace Management and associated guide on Virtual Work Arrangements are met, this directive will apply.

6.5 Accommodation

6.5.1 The standard for accommodation is a single room, in a safe environment, conveniently located and comfortably equipped.

6.5.2 A traveller who chooses private non-commercial accommodation, including their secondary residence, will be paid the rate specified in the CRA Directive on Travel Appendix B: Meals and Allowances or the CRA Directive on Travel Appendix C: Daily Meals Rates at Locations Abroad , as applicable, in this directive.

6.5.3 A traveller is to stay in institutional accommodations when travel is related to activities held in an institution subject to availability.

6.5.4 When travel plans change and the accommodation will not be required, the traveller must ensure that reservations are cancelled. Non-cancellable accommodations should not normally be booked. Delegated managers have discretion to authorize such requests.

6.5.5 For extended travel at the same location, accommodation at corporate residences, apartments, private non-commercial accommodation or government and institutional accommodation is encouraged. In instances where the CRA pays for accommodation for multiple travellers sharing the same accommodation, the private non-commercial accommodation rate is payable to only one traveller.

6.5.6 Accommodation expense at the temporary duty travel location will only be paid if the traveller maintains a residence as this entitlement is granted on the basis that a traveller incurs incremental costs while on CRA business travel.

6.5.7 The Public Services and Procurement Canada Accommodation and Car Rental Directory (external link)  must serve as a guide for the cost, location and selection of accommodation. It is the traveller's responsibility to verify the city rate limit (external link)  for their destination and determine if the supplier they wish to use has a rate within or above the limit.

• 6.5.7.1 If there is no suitable accommodation within the city rate limit, the traveller must obtain authorization from the delegated manager before booking accommodation with a rate that is above the limit and attach a justification with the travel claim.

6.5.8 If travellers will be on extended travel at the same location for more than 30 consecutive calendar days and there is a furnished apartment or corporate residence available in the surrounding area of the temporary duty travel location, those accommodations are to be selected.

• 6.5.8.1 If after the 30th calendar day of extended travel at the same location, the traveller chooses to stay in a hotel, the traveller will receive up to the average cost of the furnished apartment or corporate residence available in the surrounding area of the temporary duty travel location.

6.5.9 Travel within headquarters (HQ) area

• live-in conferences, meetings and training courses; or
• exceptional situations that require travellers to remain close to their posts for long periods in excess of normal working hours, such as policing activities during a crisis, or extended collective bargaining sessions.
• 6.5.9.2 Where authorization has been provided for overnight accommodation within the traveller's HQ area, the traveller will be paid for overnight accommodation in accordance with the requirements of section 6.5 Accommodation of this directive.

6.5.10 Travel outside HQ area

• 6.5.10.1 A traveller authorized to travel outside of the HQ area will be paid for overnight accommodation in accordance with the requirements of section 6.5 Accommodation of this directive.
• 6.5.10.2 When a traveller is required to return to the HQ area on CRA business, accommodation at the HQ area will not be paid.

6.6.1 The meal allowances contained in this directive are directed at travellers who are on travel status (reference in the Definitions section) with the exception of section 6.6.7 Travel Within HQ Area of this directive.

• 6.6.1.1 Travel within Canada and the Continental U.S.A., the meal allowances are found in the CRA Directive on Travel Appendix B: Meals and Allowances .
• 6.6.1.2 Travel outside of Canada and the Continental U.S.A., the meal allowances are found in the CRA Directive on Travel Appendix C: Daily Meals Rates at Locations Abroad .

6.6.2 Meal allowances at the temporary duty travel location will only be paid if the traveller maintains a residence as this entitlement is granted on the basis that a traveller incurs incremental costs related to meals while on CRA business travel.

6.6.3 No meal allowance will be paid when meals are provided and meet the traveller's needs, such as when the carrier serves meals on route or when the meal is included in the accommodation cost.

6.6.4 Where travellers incur out of pocket expenses to supplement meals provided, such as to meet the traveller's dietary needs, the actual costs incurred will be paid, based on receipts, up to the applicable meal allowance.

6.6.5 Where travellers must incur meal costs that are higher than the established meal rates in situations outside the travellers' control, the travellers will be paid the actual and reasonable expenses incurred for meals on that travel day, based on receipts.

6.6.6 Travellers will be paid the applicable meal allowance for each breakfast, lunch and dinner while on travel status.

6.6.7 Travel within HQ area

• when travellers are required to work through or beyond normal meal hours and are clearly placed in situations of having to spend more for the meal than would otherwise be the case;
• when travellers are required to attend conferences, seminars, meetings or public hearings during the weekend or holidays;
• when travellers are required to attend formal full-day conferences, seminars, meetings or hearings and where meals are an integral part of the proceedings;
• when the CRA representatives are involved in collective bargaining proceedings;
• when intensive task force or committee studies are enhanced by keeping participants together over a normal meal period;
• when the reimbursement of meal expenses is clearly reasonable and justifiable as a direct result of a traveller's duties; or
• when covered by the terms and conditions of employment or collective agreements.

6.6.8 Travel outside HQ area

• 100% of the applicable daily meal allowance from day 1 through day 30;
• 75% of the meal allowance starting on day 31 through day 120, when corporate residences or furnished apartments are available to travellers in the area surrounding the temporary duty travel location, or when travellers choose to stay in private accommodation; and
• 50% of meal allowance on day 121 onwards when corporate residences or furnished apartments are available to travellers in the area surrounding the temporary duty travel location, or when travellers choose to stay in private accommodation.
• 6.6.8.2 If no corporate residences or furnished apartments are available in the area surrounding the temporary duty travel location resulting in the traveller having to stay in a regular hotel, 100% of the applicable daily meal allowance will be covered. Justification must be provided with the travel claim.
• 6.6.8.3 Where travellers are occupying their secondary residence for CRA business purposes, the travellers are entitled to be paid the applicable meal allowances for private accommodation in accordance with the CRA Directive on Travel Appendix B: Meals and Allowances or CRA Directive on Travel Appendix C: Daily Meals Rates at Locations Abroad .

6.7 Incidental expense allowance

6.7.1 The incidental expense allowance contained in this directive are directed at travellers who are on travel with an overnight stay. Incidental expense allowance:

• 6.7.1.1 Travel within Canada and the Continental U.S.A. are found in the CRA Directive on Travel Appendix B: Meals and Allowances .
• 6.7.1.2 Travel outside of Canada and the Continental U.S.A. are found in the CRA Directive on Travel Appendix C: Daily Meals Rates at Locations Abroad .

6.7.2 For extended travel at the same temporary duty travel location, travellers will receive:

• 100% of the daily incidental expense allowance from day 1 through day 30; and
• 75% of the incidental expense allowance from day 31 onward when corporate residences or furnished apartments are available to travellers in the area surrounding the temporary duty travel location, or when the travellers choose to stay in private accommodation.

6.7.3 Where travellers are occupying their secondary residence for CRA business purposes, the travellers are entitled to be paid the applicable incidental expense allowance in accordance with the CRA Directive on Travel Appendix B: Meals and Allowances or CRA Directive on Travel Appendix C: Daily Meals Rates at Locations Abroad .

6.8 Transportation

6.8.1 The delegated manager, in consultation with the traveller, selects the mode of transportation.

6.8.2 The selection of the mode of transportation must be based on cost, duration, convenience, safety and practicality. The CRA’s Departmental Sustainable Development Strategy  must be taken in consideration when looking at travel options.

6.8.3 Where travellers are authorized to travel by a given mode and class of transportation and the travellers propose to travel to the temporary duty travel location by alternate means, the maximum amount payable for travel expenses must not exceed the cost that would have been incurred had the travellers travelled by the mode and class of transportation initially authorized.

• 6.8.3.1 Where travellers are travelling from their secondary residence or anywhere outside of the residence, the maximum amount payable for travel expenses must not exceed the cost that would have been incurred had the travellers travelled from their residence.

6.8.4 Actual and reasonable additional expenses associated with the selected modes of transportation such as seat selection will be reimbursed if prior approval from the delegated manager is obtained.

6.8.5 Taxi chits must not be used by travellers while on travel status as they are to be solely used when travelling in and around the HQ area.

6.8.6 All air travel arrangements must be booked through the Government Travel Service (GTS) except for personal portion of air travel and air travel arrangements made by contractors.

6.8.7 First class air travel is not permitted.

6.8.8 Business class air travel is not permitted within Canada, the Continental U.S.A., Caribbean, Central American countries, Bermuda, and Mexico, unless approved for exceptional circumstances by the Commissioner or Deputy Commissioner.

6.8.9 International business class air travel can be authorized by delegated managers where continuous air travel exceeds nine hours except for flights to and/or from Paris, Brussels, London and other European destinations. International business flights to these above-mentioned destinations may be authorized by the Commissioner or Deputy Commissioner under exceptional circumstances related to health, frequency of travel and timing of scheduled meetings.

6.8.10 Itineraries must be arranged to provide for an overnight stop after continuous travel time of at least nine hours unless declined by the employee.

6.8.11 Trips of less than 300 kilometres should not normally be by air except when specifically pre-authorized by the delegated manager.

Travelling to and/or from carrier terminals

6.8.12 Travellers will be reimbursed for the airport shuttle, taxi or ridesharing company fare from the traveller's residence, workplace or temporary duty travel location to the carrier's terminal and vice versa.

6.8.13 Travellers who drive a privately owned vehicle to and/or from the carrier's terminal to begin or end a period on travel status, will be paid the CRA kilometric rate specified in the CRA Directive on Travel Appendix A: CRA Kilometric Rates up to the distance between the traveller's residence, workplace or temporary duty travel location and the carrier's terminal.

6.8.14 If another person drives a traveller to and/or from the carrier's terminal, the traveller will be paid the CRA kilometric rate specified in the CRA Directive on Travel Appendix A: CRA Kilometric Rates for the round trip between the traveller's residence, the workplace or the temporary duty travel location and the carrier's terminal.

6.8.15 If a traveller and/or dependants is/are occupying a secondary residence immediately prior to the period of the traveller's travel status, the distances paid will not exceed that from the residence, workplace, and temporary duty travel location to the carrier's terminal.

Public transportation

6.8.16 Public transportation such as a bus, streetcar, subway or airport shuttle must be used whenever practical.

Taxi and ridesharing companies

6.8.17 Licensed taxis and ridesharing companies may be used on CRA business. Actual and reasonable expenses, based on receipts, will be reimbursed.

6.8.18 Rail travel in business class is allowed wherever offered by the rail company.

Traveller-driven vehicles

6.8.19 Travellers must use the most direct, safe and practical road routes and must claim expenses incurred only for distances necessarily driven on CRA business travel.

6.8.20 In the interest of safe driving, when traveller-driven vehicles are authorized, travellers will not be expected to drive more than:

• 250 kilometres after having worked a full day;
• 350 kilometres after having worked one-half day; or
• 500 kilometres on a day the traveller has not worked.

6.8.21 Travellers who drive on CRA business are to have a valid driver's license, respect all license conditions, practice safe driving, and follow all driving rules, regulations and laws that apply.

6.8.22 Travellers will be reimbursed the actual costs paid for parking the vehicle at both the workplace and at the point of call only when the cost of parking at the workplace is an additional cost that they would not normally incur.

6.8.23 Travellers will be reimbursed the actual costs of road, ferry, bridge and tunnel tolls only when these are incremental costs resulting from CRA business travel.

6.8.24 Carpooling involves the sharing of privately owned or rented vehicles for the purpose of CRA business travel and is encouraged when it is practical to do so.

CRA vehicles

6.8.25 When the CRA considers that travel by a traveller-driven vehicle is desirable, the CRA may authorize the use of a CRA vehicle, if practical.

6.8.26 Travellers must not use CRA vehicles for personal travel needs, unless specifically authorized.

6.8.27 Expenses incurred in the use of CRA vehicles will be reimbursed based on receipts.

6.8.28 Contractors are not authorized to use CRA vehicles for travel.

Rental vehicles

6.8.29 Mid-size/intermediate size cars or smaller are authorized.

6.8.30 Full-size/larger cars or other vehicle categories are authorized only when the number of passengers to be carried, the bulk or weight of the goods to be transported, or an extenuating circumstance warrants the authorization of a different vehicle category. A justification should be provided.

6.8.31 Travellers will be reimbursed the cost, based on receipts, of gasoline for the rental vehicle. Additional costs associated with winter tires and the rental cost for GPS will also be reimbursed based on receipts, if pre-authorized. The Public Services and Procurement Canada Accommodation and Car Rental Directory  shall serve as a guide for the cost and selection of vehicles.

Privately-owned vehicles

6.8.32 The kilometric rate payable when a registered vehicle is driven on CRA business in Canada will be the rate of the jurisdiction where the vehicle is registered.

6.8.33 For vehicles registered outside Canada, the kilometric rate applied will be that of the jurisdiction where the travel occurs. This rate is quoted in the CRA Directive on Travel Appendix A: CRA Kilometric Rates .

6.8.34 Delegated managers and travellers must determine the normal mode of commute to the workplace prior to approving travel under the requirements of this directive.

6.8.35 When the normal mode of commute to the workplace is a privately owned vehicle:

• 6.8.35.1 When the traveller is required to report to the workplace at the beginning of a given day prior to proceeding to point(s) of call, the distance driven between the residence and workplace is not paid.
• 6.8.35.2 When the traveller is required to report to the workplace at the end of a given day after returning from point(s) of call, the distance driven between the workplace and the residence is not paid.
• the first point of call;
• continuing on to consecutive points of call;
• to the last point of call; and
• to the residence.
• the perimeter of the HQ area to the first point of call if the first point of call is inside the HQ area; or the residence to the first point of call, if the first point of call is outside the HQ area;
• if the last point of call is outside the HQ area, the last point of call to the residence; or if the last point of call is inside the HQ area, the calculated distance to the perimeter of the HQ area.

6.8.36 When the normal mode of commute to the workplace is not a privately owned vehicle:

• the workplace (if applicable) and/or to the first point of call;
• to the workplace (if applicable) and/or to the residence.
• 6.8.36.2 If the traveller has brought a privately owned vehicle to the workplace at the delegated manager's request, but due to operational requirements, the delegated manager has determined that the privately owned vehicle would not be required for CRA business travel on that given day, the round trip will be paid between the residence and workplace.

6.8.37 The use of car sharing programs will be treated similarly to privately owned vehicles. Travellers will be paid the kilometric rates quoted in the CRA Directive on Travel Appendix A: CRA Kilometric Rates .

Motorcycles

6.8.38 Travellers using a motorcycle on CRA business will be paid the applicable rate in the CRA Directive on Travel Appendix A: CRA Kilometric Rates .

1) CRA vehicles

6.8.39 The CRA self-insures its vehicles. Only authorized employees can drive a CRA owned vehicle. Unauthorized drivers are personally liable in the event of an accident as there is no CRA liability coverage in such circumstances.

6.8.40 When driving a CRA vehicle in the Continental U.S.A., commercial insurance against third-party liability risk and personal injury is required and proof of such insurance must be carried in the vehicle. This insurance is obtained and paid for by the CRA.

2) Rental vehicles

6.8.41 Collision Damage Waiver (CDW) coverage is required for the entire period that a vehicle is rented. This coverage is provided free of charge when employees use a government approved DTC.

6.8.42 In cases where the DTC is not used and free coverage is not provided by personal credit card, the cost of the premium for the CDW will be paid by the CRA.

6.8.43 Public Liability and Property Damage (PLPD) coverage is included in the daily rental rates provided by the car rental suppliers in the Public Services and Procurement Canada Accommodation and Car Rental Directory .

6.8.44 When travelling outside Canada, including the Continental U.S.A., travellers must ensure additional coverage is obtained where required. In such circumstances, premiums for additional coverage will be paid by the CRA.

6.8.45 Insurance coverage will not be paid to contractors.

3) Privately-owned vehicles

6.8.46 The CRA assumes no financial responsibility for privately owned vehicles and is not responsible for premium costs and reimbursing deductible amounts related to insurance coverage.

6.8.47 Privately owned vehicles used on CRA business must, at a minimum, have basic insurance coverage, including the minimum PLPD coverage required by the province or territory of registration of the vehicle.

6.8.48 When Supplementary Business Insurance (SBI) is required for the applicable period on CRA business, premium costs will be paid by the CRA.

6.8.49 SBI will not be paid to contractors.

6.8.50 Travellers who intend to car share or carpool must confirm with their insurance agent that they are adequately insured.

6.9 Combined personal/business travel

6.9.1 Costs associated with personal travel or for the travel of another person accompanying travellers on CRA business travel are not reimbursable.

• 6.9.1.1 The travellers must include in their travel request the assessment of the financial impact of the personal portion of their trip.
• 6.9.1.2 Travellers will not be paid for any reduction in cost for the CRA business travel resulting from the personal travel plans.
• 6.9.1.3 Travellers will be paid only the cost of the most economical and direct route that would have been taken had no personal travel arrangement been incorporated.

6.10 Overtime and other disruption to commute

6.10.1 When there is a disruption in the employee's regular commuting pattern such as overtime or other exceptional circumstances, approved by the Commissioner, such as public health emergency, the employee will be paid additional transportation costs incurred between the residence and the workplace.

6.11 Additional expenses

Passports and medical service fees.

6.11.1 For travel outside Canada, necessary arrangements for obtaining an appropriate passport (excluding birth certificates), visa, required inoculations, vaccinations, X rays and certificates of health will be reimbursed by the CRA based on receipts.

Financial fees

6.11.2 Service charges or fees for actual and reasonable expenses for financial transactions will be reimbursed by the CRA to employees based on receipts.

6.11.3 Costs incurred to convert reasonable sums to foreign currencies and reconvert any unused balance to Canadian currency will be reimbursed by the CRA to employees based on receipts.

• 6.11.3.1 When these costs are not supported by receipts, the average Bank of Canada currency exchange rate will apply.

6.11.4 For travel outside Canada and the Continental U.S.A., employees will be reimbursed the incremental cost (that is, costs not covered by the Public Service Health Care Plan) of the prescription and actual cost of non-prescription medications, based on receipts that are specifically purchased for use by the employee at the foreign temporary duty travel location(s).

Bottled water

6.11.5 For travel outside of Canada and the Continental U.S.A., the cost of bottled water will be reimbursed, based on receipts.

6.11.6 For travel within Canada and the Continental U.S.A., the cost of bottled water is reimbursed, based on receipts, only when the water is non potable.

Dependant care

6.11.7 Dependant care expenses will be paid up to a daily maximum of:

• $35 per household with a declaration instead of a receipt; or
• $75 per household, with a receipt for services provided by an individual or a company in the business of providing dependant care services.

6.11.8 The above noted amounts apply when:

• the employee is required to be absent from the residence on authorized CRA business travel;
• the employee is the sole caregiver, or the employee's spouse or other dependant 18 years of age or older, is unavailable for reasons related to work, medical appointments or education courses;
• the dependants, residing in the employee's residence are all under 18 years of age; or when the individuals 18 years of age or over remaining at the residence are dependant on the employee for reasons of either physical or mental disability; and therefore unable to provide care;
• the former spouse, common law partner, or guardian is not scheduled to provide care;
• dependant care expenses are additional expenses incurred by the employee resulting from travelling.

6.11.9 For reimbursement of services under this requirement, the employee must complete and submit the TF750 Dependant Care form with the travel claim.

Home communication

6.11.10 Employees, whose schedules for returning to the residence from travel status have been altered for reasons outside their control, shall be reimbursed the cost of a three-minute call to the residence. A receipt is not required. The change in schedule shall be noted on the travel claim.

6.11.11 Other personal calls are not paid for when travelling within Canada and the Continental U.S.A.

6.11.12 The following entitlements apply to travel outside Canada and the Continental U.S.A.:

• 6.11.12.1 Employees on travel status will be paid, based on receipts, for a daily maximum equivalent to one five-minute personal telephone call. The maximum five minute per day telephone call is cumulative.
• 6.11.12.2 Personal telephone calls will be paid at a rate not to exceed the rate from the temporary duty travel location to the residence.
• 6.11.12.3 The daily five-minute personal telephone call provision can be exceeded for actual and reasonable expenses incurred for personal needs in unusual circumstances such as when travelling in high-risk locations, and medical emergencies at the residence, etc.

Business communication

6.11.13 Employees on travel status will be paid, based on receipts, for the costs incurred for local and long distance telephone calls placed as a result of CRA business. Business phone calls should be supported by the name of the person called.

Special assistance

6.11.14 Where a traveller with physical disabilities is required to pay for special assistance in travel (for example, taxi driver or porter), these costs will be reimbursed as additional incidental expenses, provided they are reasonable and necessary. Receipts should be provided where possible.

6.12 Weekend travel to the residence

6.12.1 The use of weekend travel to the residence requirements does not constitute a break in continuous travel at the same location.

6.12.2 An employee who is on travel status that extends through or beyond a weekend is eligible for weekend travel to the residence provision of this directive provided that the following conditions are met:

• work schedules permit the employee to be absent; and
• appropriate private or public transportation is available and its use is both practical and reasonable.

6.12.3 The requirements for weekend travel to the residence do not permit employees to be paid overtime or travel entitlements other than what is outlined in section 6.12 Weekend Travel to the Residence of this directive for travel between the temporary duty travel location and the residence.

6.12.4 The employee must work the full daily number of required hours at the temporary duty travel location prior to and following the weekend.

6.12.5 Where the employee requests to travel to the residence during normal hours of work, the delegated manager has discretion as to how the employee will compensate or report for those hours.

6.12.6 No accommodation, meals or incidentals are paid at the employee's residence.

6.12.7 - Travel in Canada and the Continental U.S.A.

• travel to the residence every weekend on average;
• travel to the residence every third weekend on average;
• weekend travel alternative – by the employee; or
• weekend travel alternative – by another person
• 6.12.7.2 Delegated managers and their employees must agree prior to the beginning of a CRA business trip whether to travel to the residence every weekend or to travel to the residence every third weekend. That choice cannot be changed during the term of the travel.

Travel to the residence every weekend on average

• If the accommodation is cancelled for the weekend, the cost of maintaining the employee on travel status over the weekend (that is, accommodation, meals, incidentals and other expense allowances); or
• If the accommodation is not cancelled for the weekend, the weekend travel to the residence transportation allowances in the CRA Directive on Travel Appendix B: Meals and Allowances for two, three or four day weekends as applicable.
• 6.12.7.4 Actual transportation costs payment limit described in section 6.12.7.3 Travel to the Residence Every Weekend on Average of this directive will be reduced by any costs incurred by the CRA on behalf of the employee at the temporary duty travel location during the period of absence, such as hotel accommodation or car rental, where the employee could have cancelled and provided cost savings.

Travel to the residence every third weekend on average

• 6.12.7.5 When the period of continuous travel status is in excess of 30 consecutive calendar days and is so far from the residence that travel to the residence every weekend is impractical, the employee may return to the residence on average every third weekend. Actual transportation costs to the residence are paid for and the accommodation at the temporary duty travel location need not be cancelled.
• one trip to the residence for travel of 4 weeks' duration;
• two trips to the residence for travel of 7 weeks' duration; and
• three trips to the residence for travel of 10 weeks' duration.

6.12.8 Travel outside Canada or the Continental U.S.A.

• 6.12.8.1 Requirements from sections 6.12.1 to 6.12.6 Weekend Travel to the Residence of this directive continue to apply for weekend travel to the residence while on Travel Outside Canada or the Continental U.S.A.
• 6.12.8.2 When the period of continuous travel status is in excess of 30 consecutive calendar days and is so far from the residence that travel to the residence every weekend is impractical, the employee may return to the residence on average every fifth weekend. Actual transportation costs are paid to the employee and the accommodation at the temporary duty travel location need not be cancelled.
• one trip to the residence for travel of 7 weeks' duration;
• two trips to the residence for travel of 12 weeks' duration;
• three trips to the residence for travel of 17 weeks' duration; and
• four trips to the residence for travel of 22 weeks' duration.

6.13 Weekend travel to the residence – alternatives

By the employee.

6.13.1 Provided that the employee is not required by the CRA to remain at the temporary duty travel location, an employee may choose to spend the weekend at an alternative location.

6.13.2 Such arrangements must be made in consideration of security and diplomatic contexts.

6.13.3 To be eligible for weekend travel to the residence alternatives provisions, the employee must cancel charges for accommodation (and meals provided on site) at the temporary duty travel location, provide a receipt for alternative commercial accommodation when used and not return home or to the HQ area during the weekend.

6.13.4 Amount paid for travel arrangements at the alternative location will not exceed the cost of maintaining the employee at the temporary duty travel location including the cost of accommodation, meals, incidentals and other expenses.

6.13.5 Amount paid for travel arrangements at the alternative location will be reduced by any costs incurred by the CRA on behalf of the employee at the temporary duty travel location during the period of absence. Transportation costs related to travel to an alternate location will not be paid.

6.13.6 Arrangements are the personal responsibility of the employee without using the government approved services. The employee assumes personal liability as if the employee was not on travel status.

6.13.7 The use of this provision does not preclude the employee's entitlement to weekend travel to the residence.

By another person

6.13.8 As an alternative to weekend travel to the residence by the employee, another person may be authorized to travel to the employee's temporary duty travel location when the transportation cost does not exceed the cost of the employee taking a weekend travel to the residence as per 6.12.7 and 6.12.8.

6.13.9 Such arrangements must be made in consideration of security and diplomatic contexts.

6.13.10 The airfare and pertinent travel arrangements must be processed through the government suppliers unless there are other more practical and economical modes of transportation.

6.13.11 Ground transportation to and from the public carrier will be paid.

6.13.12 The CRA kilometric rate will apply if a traveller-driven vehicle is used.

6.13.13 Insurance coverage for the other person is the responsibility of the employee.

6.13.14 The CRA will only cover the transportation costs for the other person and will not be responsible for any other expenses incurred by this person.

6.14 Overpayments

6.14.1 Amounts paid to travellers, which are not in accordance with the terms of this directive, will be recovered from the traveller as a debt owing to the Crown.

6.15 Loyalty programs

6.15.1 Provided there are no additional costs to the CRA, travellers on CRA business travel can join loyalty programs and retain benefits, for business or personal use, offered by government approved services and products in the travel industry.

6.16 Executive (EX) Group and the Board of Management (Board)

6.16.1 In addition to the travel requirements noted in this directive, some flexibility guided by the Treasury Board's Special Travel Authorities  has been added to the CRA Executive (EX) Group while on travel status.

6.16.2 The EX Group includes all CRA EXs (excluding equivalent groups or acting positions), including minister's exempt staff equivalent to EX-02 and above travelling on departmental business, as well as Board members whose terms of travel are not otherwise specified on appointment.

6.16.3 Transportation

• 6.16.3.1 Actual expenses may be claimed for taxis and parking, without receipts.

6.16.4 Meals

• 6.16.4.1 Claims may include the daily meal allowances or actual and reasonable meal expenses based on receipts.
• 6.16.4.2 When actual expenses are claimed for a given meal, meal allowances are applicable to other meals purchased that day (and no receipts are required).

6.16.5 Incidental expense allowance

• 6.16.5.1 Claims may include the daily incidental expense allowance or actual expense under exceptional circumstances based on receipts. However, if one decides to claim actual incidental costs instead of the pre-determined incidental expense allowance, then all incidental expenses reimbursements incurred on that trip will be on the basis of receipts.

6.17 Commissioner

6.17.1 Is subject to this directive but has discretion over commercial accommodation selected, telephone calls and meals and incidentals in excess of the per diems, based on receipts.

6.17.2 Has discretion over use of business class travel, however it must be booked through the GTS.

6.18 Contractors

6.18.1 Contractors are paid the meals, kilometric rates and incidental expense allowances specified in the CRA Directive on Travel Appendix A: CRA Kilometric Rates , CRA Directive on Travel Appendix B: Meal and Allowances , CRA Directive on Travel Appendix C: Daily Meal Rates at Locations Abroad .

6.18.2 Contractors are not entitled to home communication, dependant care and weekend travel to the residence expenses.

6.18.3 Contractors who use a private motor vehicle are entirely responsible for the management and underwriting of risk pertaining to the operation of the vehicle. Insurance premiums are paid by the contractor and are not reimbursed by the CRA other than through the payment of the kilometric allowance in the CRA Directive on Travel Appendix A: CRA Kilometric Rates .

6.19 Recovery of travel costs from third parties

6.19.1 The CRA does not recover travel costs from third parties when the conference or seminar is related to fulfilling the CRA's mandate.

6.19.2 The CRA may recover, from external organizations, travel expenses incurred by travellers who are:

• invited by external organizations to represent the CRA at conferences and seminars; or
• required to travel outside of Canada to review books and records as part of the Compliance Programs Branch's audit program.

6.20 Death, emergencies, illnesses, and injuries while travelling

Death while travelling.

6.20.1 If an employee dies while travelling, the CRA will authorize the payment of necessary expenses that are additional to those which might have been incurred had the death occurred in the HQ Area.

Emergencies, illnesses and injuries while travelling

6.20.2 An employee shall be reimbursed the necessary expenses incurred as a result of illness or accident occurring while travelling that are additional to those which might have been incurred had the employee not been absent from their residence, and which were not otherwise payable to the employee under an insurance policy, the Government Employees Compensation Act (GECA), or other authority.

6.20.3 Members of the Board are considered "employees" under the GECA and the Aeronautics Act and are therefore eligible to employment injury benefits, in the event of injury or death while attending or traveling on Board business.

6.21 Process for handling grievances

6.21.1 In cases of alleged misinterpretation or misapplication arising out of this directive, employees may grieve by filing a grievance in accordance with Procedures for handling grievances.

7. Roles and responsibilities

7.1 chair of the audit committee.

7.1.1 Reviews the Commissioner's travel expenses on a regular basis and reports the findings to the Audit Committee.

7.2 Commissioner

7.2.1 Approves exceptions to the requirements of this directive, including exception requests from the members of the Board of Management.

7.2.2 Authorizes business class air travel requests as outlined in this directive.

7.2.3 Approves exceptional circumstance of disruption to commute.

7.3 Deputy commissioner

7.3.1 Authorizes business class air travel requests as outlined in this directive.

7.4 Chief financial officer and assistant commissioner, Finance and Administration Branch

7.4.1 Reviews and approves the travel claims of the commissioner and deputy commissioner.

7.4.2 Reviews and publishes the rates for accommodation, meals, incidental expense allowance and kilometres for travel on a periodic basis.

7.5 Director of the Financial Reporting and Accounting Division, Finance and Administration Branch

7.5.1 Provides guidance and advice pertaining to processes, procedures, systems and controls supporting the management of travel expenditures.

7.5.2 Develops tools and provides training supporting the management of travel expenditures.

7.5.3 Liaises with Public Services and Procurement Canada and external suppliers for the management of travel services and travel cards.

7.5.4 Performs monitoring and verification activities pertaining to the processing of travel expenditures to ensure compliance with CRA CPIs.

7.6 Delegated managers with commitment authority (section 32 of the Financial Administration Act) and certification authority (section 34 of the Financial Administration Act)

7.6.1 Approve travel requests and claims as per the requirements of this directive.

7.6.2 Authorize all travel arrangements, including airline or rail tickets, accommodation, and meals, in accordance with the requirements of this directive through the Manager Self-Service (MSS) prior to travel.

7.6.3 Consider environmentally-preferred alternatives that are cost effective when authorizing travel arrangements.

7.6.4 Approve trips of less than 300 kilometres by air.

7.7 Employees/travellers

7.7.1 Seek authorization from the delegated manager for all travel arrangements and travel requests, including details of their needs that may require special accommodation, through the Employee Self-Service (ESS).

7.7.2 Submit travel claims for expense reimbursement through ESS within 30 calendar days after the travel is completed, including all necessary supporting documentation, receipts and explanations as required. For the purposes of the year-end exercise, travel claims should be submitted within the first 5 business days of the month of April, at the latest.

7.7.3 Retain original documents until such time as the pre or post payment audit has been completed and the CRA is satisfied that the electronic documents are legible, approximately 90 calendar days from the electronic submission date.

7.7.4 Safeguard travel advances and funds provided.

7.7.5 Resolve uncertainties related to travel entitlements by contacting the specified contacts that are outlined in section 10 of this directive prior to making travel arrangements.

7.7.6 Consider environmentally-preferred alternatives that are cost effective when selecting travel arrangements to support the Sustainable Development Policy  and the outlined goals, targets and activities in CRA’s Departmental Sustainable Development Strategy .

7.8 Administration Directorate, Finance and Administration Branch

7.8.1 Ensures travel entitlements in contracts are in accordance with the requirements of this directive.

7.8.2 Includes the travel rates and allowances in contracts— CRA Directive on Travel Appendix A: CRA Kilometric Rates , CRA Directive on Travel Appendix B: Meal and Allowances ,CRA Directive on Travel Appendix C: Daily Meal Rates at Locations Abroad , that will be used as a basis for contractors' reimbursement.

8. Review and assessment

The director of the Systems, Policy and Control Division of the Finance and Administration Branch (FAB) is responsible for the scheduled review of this directive every five years, as well as any unscheduled reviews when necessary.

To support the review process, FAB will identify and undertake any monitoring and assessment activities to help it determine if the directive is effective and being followed.

9. References

The Directive on Travel is based on the authorities set out in the legislation listed below.

Legislation

• Aeronautics Act
• Canada Revenue Agency Act
• Financial Administration Act
• Governance Employees Compensation Act
• Privacy Act

Related instruments and information:

• Code of Integrity and Professional Conduct
• Collective agreements
• CRA Foundation Framework for Corporate Policy
• CRA's Departmental Sustainable Development Strategy
• Delegation of Spending and Financial Authorities for Agency Activities, Directive on
• Discipline, Directive on
• Driver Safety Standard Operating Procedures
• Financial Management and Financial Administration, Policy Framework for
• Financial Management and Financial Administration, Policy on
• International Air Transport Association
• International Relations and Treaties Office
• Policy on Workplace Management
• Pre-approval of Travel, Hospitality, Conferences and Event Expenditures , Directive on
• Procedures for handling grievances
• Public Services and Procurement Canada Accommodation and Car Rental Directory
• Relocation, Directive on
• Sustainable Development Policy
• TBS Special Travel Authorities
• T2200-Declaration of Conditions of Employment form
• TD4-Declaration of Exemption -Employment at Special Worksite
• TF750-Dependant Care form
• Virtual Work Arrangements

10. Enquiries

Direct questions about this directive as indicated in the following table:

11. Version history

12. definitions.

The following key terms, found in this directive, are defined in the FAD Lexicon:

• Actual and reasonable expenses
• Basic insurance
• CRA business travel
• CRA kilometric rate
• Car sharing
• Commercial accommodation
• Continuous air travel
• Continuous travel time
• Corporate residence
• Declaration
• Delegated managers
• Designated Travel Card (DTC)
• Extended travel
• Government and institutional accommodation
• Government Travel Service (GTS)
• Headquarters Area
• Incidental expense allowance
• Live-in conferences
• Point of call
• Private non-commercial accommodation
• Ridesharing
• Secondary Residence
• Spouse or Common-law partner
• Supplementary business insurance (SBI)
• Temporary duty travel location
• Travel status

13. Appendices

• CRA Directive on Travel Appendix A: CRA Kilometric Rates
• CRA Directive on Travel Appendix B: Meals and Allowance
• CRA Directive on Travel Appendix C: Daily Meal Rates at Locations Abroad

Page details

Guidance for Screening for Tuberculosis Infection and Disease during the Domestic Medical Examination for Newly Arrived Refugees

Overview of overseas tuberculosis screening for refugees, documentation of overseas tb evaluation, domestic refugee screening for tuberculosis, overview of treatment.

• As part of the domestic screening, all overseas medical records should be reviewed, a thorough medical history obtained, and a physical examination completed.
• All refugee applicants (aged ≥2 years) must undergo evaluation overseas for tuberculosis (TB) and are assigned one or more TB classifications prior to departure. Overseas TB screening results, treatment, and classifications are documented on the US Department of State (DS) forms.
• If Interferon Gamma Release Assay (IGRA) was negative overseas (within the last 6 months), and there are no signs or symptoms of TB disease upon physical examination, no further domestic evaluation is needed.
• If the overseas IGRA was negative but performed ≥6 months prior to the domestic examination, repeat IGRA.
• Treatment for latent tuberculosis infection (LTBI) should be considered after TB disease is ruled out for those with positive IGRA results, unless TB disease or LTBI treatment was completed prior to arrival.
• For children aged <2 years, a tuberculin skin test (TST) is recommended (if not previously treated for LTBI or TB disease).
• If IGRA was not done overseas or a negative IGRA was documented > 6 months prior, an IGRA is recommended at the domestic examination.
• If overseas or domestic IGRA is positive, LTBI treatment should be considered after TB disease is ruled out (if not previously treated for LTBI or TB disease).
• Any refugee, regardless of country of origin, with signs or symptoms of TB disease should undergo clinical evaluation for TB disease
• Differentiating between LTBI and TB Disease (Pulmonary)

Source: CDC Division of Tuberculosis Elimination

This guidance briefly describes the overseas TB medical screening process for refugees resettling to the United States and outlines the evaluation of newly arrived refugees for TB during the domestic medical screening examination. This document supplements guidelines for the general US patient population, and highlights specific needs among refugees to be used in conjunction with current guidelines from national authorities (American Thoracic Society [ATS]/Centers for Disease Control and Prevention [CDC]/ Infectious Diseases Society of America [IDSA]) and state TB control programs.

From 2018 to 2019, the number of TB disease cases in the United States decreased by 1.2% [ 1 ]. Additionally, in 2019, the TB rate was 2.7 per 100,000 people, the lowest rate on record [ 1 ]. While TB is decreasing overall in the United States, country of birth continues to be a major risk factor for TB in the United States, with the majority of reported TB cases occurring among non-US born persons (71.4%) [ 1 ]. The prevalence of drug-resistant TB or extrapulmonary TB cases, which are more challenging to diagnosis and manage, is also higher among foreign-born persons [ 2 ]. Studies have indicated that reactivation of LTBI, rather than recent transmission, is the primary driver of TB disease in the United States, accounting for >80% of all TB cases [ 2 ].

Additionally, 13.5% of cases among non-US born persons occurred within one year of arrival in the United States [ 1 ]. It is important to identify and treat new arrivals with LTBI soon after arrival [ 3 ]. The risk of TB disease appears to remain high for many years after resettlement, making it essential that clinicians find and treat LTBI before TB disease develops [ 4 ]. Healthcare providers who serve refugees should maintain a high index of suspicion for TB disease even long after arrival [ 5 ]. CDC and the US Preventive Services Task Force (USPSTF) recommend LTBI screening and, if positive, treatment for LTBI for persons who were born in, or have lived in, countries with high TB prevalence [ 6 , 7 ].

Before departure for the United States, all refugees must undergo an overseas medical examination that focuses on inadmissible conditions, including TB disease. By law, refugees diagnosed with an inadmissible condition are not permitted to depart for the United States until the condition has been treated. CDC stipulates the content of this examination through Technical Instructions (TIs)  issued to panel physicians and organizations that perform the medical screening examinations. Figure 1 outlines the required TB screening components for refugees being resettled to the United States from countries with a high burden of TB. CDC defines high burden for the purposes of screening as any country with a WHO-estimated TB disease incidence rate of ≥20 cases per 100,000 population.

Figure 1. Tuberculosis screening for applicants in high tuberculosis burden countries

View large image and text description

Source: CDC Division of Global Migration Health, Tuberculosis Technical Instructions for Panel Physicians

Note: All applicants <2 years of age living in high burden countries must have a physical examination and history provided by a parent or guardian. Applicants who have signs or symptoms suggestive of TB disease or have known HIV must have an IGRA or TST and a chest x-ray (CXR). Applicants with signs or symptoms suggestive of TB disease must provide three sputum specimens to undergo microscopy for acid-fast bacillus (AFB), as well as culture for mycobacteria, and drug susceptibility testing for positive cultures.

Classifications and Travel Clearance All refugee applicants must be assigned one or more TB classifications. TB classification is determined by screening results, and treatment, if required. Table 2 describes the TB classifications and travel clearance for all refugee applicants.

Table 2. TB Classifications and Travel Clearance

*Directly observed therapy (DOT) is the required form of treatment for applicants diagnosed with tuberculosis disease during medical screening. Treatment of tuberculosis disease must be administered following Division of Global Migration Health (DGMH)-defined DOT  policies and practices during the entire course of therapy.

Note: Applicants can be both Class B1 and Class B3, or Class B2 and Class B3. However, other combinations of TB classifications are not permitted.

Panel physicians must document TB screening and treatment results on the DS 2054 ( Medical Examination ), DS 3030 ( TB Worksheet ), and DS 3026 ( Medical History and Physical Examination Worksheet ). All medical documentation must be included with the required DS forms. Refugees receive copies of these documents and should provide them to the evaluating provider in the United States. In addition, the information is available through CDC’s Electronic Disease Notification (EDN) system to state or local health departments. Evaluating providers in the United States who are not receiving this information should contact the State Refugee Coordinator or state refugee health program for guidance. Overseas medical documents include information pertinent to the TB evaluation, such as—

• Medical history and physical examination
• The IGRA laboratory report (if the test was indicated) or TST documentation (including name of product, expiration date, amount administered) if IGRA is not licensed in the country where screening is conducted
• Digital CXR file for all applicants aged ≥15 years and, when indicated, for younger applicants
• Sputum smear and culture results for TB, if required
• DOT regimen received, including doses of all medications, start and completion dates, and periods of interruption
• Radiology reports of CXR findings before, during, and after treatment
• Clinical course, such as clinical improvement or lack of improvement during and after treatment
• Sputum smear AFB microscopy results obtained before, during, and after treatment
• Reports of cultures for mycobacteria obtained before, during, and after treatment, including reports of contamination
• Drug susceptibility test results for an tuberculosis isolate
• IGRA laboratory report, including all numeric values

All refugees, including those classified with a TB condition overseas, should receive a comprehensive domestic medical screening within 90 days of arrival. The goal of the domestic screening for TB is to find persons with LTBI, in order to facilitate prompt treatment and control, and to find persons who may have developed TB disease since the overseas medical examination.

Medical History and Physical Examination of Refugees for Tuberculosis during the Domestic Medical Screening Evaluation

TB disease should be encountered infrequently during the domestic medical screening examination because all new arrivals have been screened for TB disease prior to departure. Clinicians should be aware that the overseas medical exam is aimed at diagnosing pulmonary TB disease and may fail to detect extrapulmonary disease. Therefore, it is important for clinicians to perform a thorough history and physical examination aimed at identifying any refugee who may have pulmonary or extrapulmonary TB disease. Some persons with TB disease have minimal symptoms, and a high index of suspicion should be maintained for those with any concerning history, such as household exposure to TB, or signs of active disease.

Symptoms of pulmonary TB are often indolent and nonspecific, and include malaise, weight loss, night sweats, cough, chest pain, fever, and hemoptysis. Symptoms of extrapulmonary TB disease generally reflect the organ involved (e.g., abdominal pain with gastrointestinal TB). Although extrapulmonary TB can be found in nearly any organ of the body, lymph nodes, including those in the thorax, are the most common extrapulmonary sites.

All predeparture medical records for the refugee should be closely reviewed. A thorough post-arrival medical history should be obtained. In addition to current signs or symptoms of TB disease (e.g., weight loss, night sweats, fever, cough), specific information may be helpful in recognizing persons who might have TB disease or LTBI:

• Previous history of TB
• Prior treatment suggestive of TB treatment
• Prior diagnostic evaluation suggestive of TB
• Family or household contact with a person who has or had TB disease, treatment, or diagnostic evaluation suggestive of TB

In addition, in children, a history of recurrent pneumonias, paroxysmal wheezing, failure to thrive, or recurrent or persistent fevers should increase the index of suspicion.

For general guidance on the physical examination, see History and Physical Examination Screening Guidance . The examination for TB should focus on inspection and palpation of all major palpable lymph node beds and a careful skin examination, as it may reveal cutaneous disease, scars from scrofula or bacille Calmette-Guérin (BCG) vaccination, or hints of prior chest surgery.

Testing Newly Arrived Refugees for TB Infection and Disease

The overseas medical exam is universal for all refugees. Results of overseas TB testing and treatment should be available to domestic clinicians for review for all refugee arrivals from TB endemic countries.

For children 2 to 14 years of age coming from endemic countries (TB incidence rate of ≥ 20 cases per 100,000 population), an IGRA result should be available. If the IGRA was negative and performed <6 months before departure, and if the child has no signs or symptoms of TB disease upon physical examination, no further evaluation is needed. Additionally, if the IGRA was positive and the child completed TB disease or LTBI treatment prior to the domestic examination and has no signs or symptoms of TB disease upon physical examination, no further evaluation is needed. If the IGRA was negative but performed ≥6 months prior to the domestic examination, a repeat IGRA should be performed. For children aged <2 years from endemic countries, LTBI testing is recommended, if not previously treated for TB disease or LTBI. Currently, TST is the preferred test for children age <2 years. Skin testing and interpretation should be done in accordance with the ATS/CDC/IDSA Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children .

Refugees > 15 years of age are universally screened with a CXR prior to arrival in the US. Refugees > 15 years of age who have clinical signs or symptoms of TB disease, or have a positive CXR, or who are HIV positive, will have had three sputum smears and three sputum cultures performed prior to arrival. If they are diagnosed with TB disease, they receive full DOT prior to arrival. If a refugee ≥15 years has LTBI diagnosed prior to arrival but has not received LTBI treatment, they should be offered treatment if they have no current no signs or symptoms suggestive of TB disease and no contraindications to treatment. A refugee aged > 15 years who had a normal CXR prior to departure should be offered an IGRA if—

• overseas IGRA was not performed
• overseas IGRA results are unavailable or
• overseas IGRA screening was performed > 6 months prior and results were negative.

Any new arrival, regardless of country of origin, with signs or symptoms of TB should undergo clinical evaluation for TB disease.

Figures 2 and 3 outline the domestic screening algorithms for most refugee children aged 2–14 years and refugees aged > 15 years, respectively. Further information regarding domestic screening is detailed below.

Figure 2. Domestic screening protocol for refugees who had an IGRA test prior to departure (most children aged 2–14 years)

*In rare circumstances, refugees may receive LTBI treatment prior to departure. In this case, if no signs or symptoms of TB disease, further evaluation is not needed.

**Refugees that received tuberculosis therapy as DOT, carefully supervised by a US panel physician, will be classified as B0. Those treated outside the panel physician system will be classified as B1 TB, Pulmonary. State and local TB officials will be notified via the EDN of arrivals with Class B status.

Note: Either IGRA or TST are acceptable tests. However, IGRA is preferred for children ≥5 years of age.

Figure 3. Domestic screening protocol for refugees who did not have overseas IGRA testing but had a CXR (most refugees aged > 15 years)

* Refugees that received tuberculosis therapy as DOT, carefully supervised by a US panel physician, will be designated with a B0 classification. Those treated outside the panel physician system will be classified as B1 TB, Pulmonary. State and local TB officials will be notified via the EDN of arrivals with Class B status.

**In rare circumstances, refugees may receive LTBI treatment prior to departure. In this case, if no signs or symptoms of TB disease, further evaluation is not needed.

Note: Either IGRA or TST are acceptable tests. However, IGRA is preferred for persons ≥5 years of age.

When domestic LTBI screening is offered, either IGRA or TST are acceptable tests (IGRA is preferred for those aged ≥5 years). A summary of recommended uses, benefits, and limitations for IGRA and TST can be found in the ATS/CDC/IDSA Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children  It should be noted that a negative IGRA or TST result does not eliminate TB disease from the differential diagnosis in a patient with signs or symptoms of TB disease. Additionally, a positive test result, from either IGRA or TST, should be accompanied by an evaluation for TB disease with a thorough history and examination for signs and symptoms, and a CXR.

TB Blood Tests (Interferon Gamma Release Assay [IGRA])

An IGRA is a blood test used to determine if a person is infected with M. tuberculosis . IGRAs measure the immune response to TB proteins in whole blood. Currently, QuantiFERON®-TB Gold Plus (as of March 2020 manufactured by Qiagen) and T-SPOT®. TB (Oxford Immunotec) are the two IGRAs currently approved in the United States. It is important to note that TB blood tests should not be performed on a person who has written documentation of either a previous positive TB test result (TB blood test or TST) or treatment for TB disease.

For additional information on TB blood tests, refer to the Latent Tuberculosis Infection, A Guide for Primary Health Care Providers [PDF – 60 pages] .

Mantoux Tuberculin Skin Test (TST)

In otherwise healthy refugees from areas of the world where TB is common, ≥10 mm of induration is considered a positive result. A cutoff of ≥5 mm of induration is considered a positive result in persons with HIV infection, those with recent close contact with a known case of infectious TB, persons with fibrotic changes on CXR consistent with prior TB, persons with organ transplants, and other immunosuppressed persons. Many refugees from TB-endemic areas have been vaccinated against TB with BCG vaccine. IGRA is preferred for testing persons who have been vaccinated with BCG. Although previous BCG vaccination may influence TST results, especially in infants, a history of vaccination with BCG should not influence interpretation of TST results in adults. Many refugees will believe their test is positive due to past BCG vaccination. Clinicians should be prepared to thoroughly explain to the patient the reasons for not considering BCG vaccination in the interpretation of TST or IGRA results.

TST testing can be performed in all persons, including children and pregnant women. However, the test is contraindicated for persons who have had a local reaction with blistering or a systemic allergic response. False negative results may be more frequent in young children and in persons with a compromised immune system. False negatives also may occur more commonly in populations with highly prevalent M. tuberculosis infection (a high pretest probability). A TST should be administered and read by a specifically trained healthcare provider. For additional information about performing a TST, visit the CDC TB website .

Diagnostic Evaluation

Chest radiography.

Any patient with signs or symptoms of TB disease should have a CXR. If recent CXRs from the overseas medical exam are available and there has been no change in clinical status (no new signs or symptoms of pulmonary or extrapulmonary TB disease), there is no need to repeat the CXR. However, clinical judgment should be used in each case. If documentation is not available at the initial screening visit, providers should contact their State Refugee Coordinator, or the CDC ( [email protected] ) to obtain overseas testing results. If overseas CXR results cannot be obtained, or the test was done > 6 months prior and the result was negative, repeat CXR should be performed.

A posterior-anterior (PA) radiograph should be the primary image obtained in adults and older children. In children too young to cooperate with PA positioning, an anteroposterior (AP) view should be obtained. Additionally, a lateral chest radiograph is recommended in children <10 years old, because hilar adenopathy, a common pediatric TB finding, can be difficult to visualize on a PA or AP view. Any new CXR should be compared to previous films. Pregnant women with a positive TST or IGRA or other CXR indication should be protected with wraparound abdominal and pelvic lead shielding during chest radiography.

When the CXR has suspicious findings, or other signs or symptoms of TB are present, sputum specimens must be collected for smear and culture testing. Further information on testing can be found in the ATS/CDC/IDSA Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children .

Confirmed LTBI

Some states require LTBI reporting. Refugees with positive IGRA or TST results and normal findings on CXR should be offered LTBI treatment in accordance with CDC guidelines [8]. Information on how to choose the most effective treatment regimen for each patient, adverse drug effects, monitoring, and assessing adherence is available on the CDC TB website .

Suspected or Confirmed TB Disease

Screening results indicating TB disease may include a combination of a positive results from IGRA or TST, abnormal findings on CXR, pathology findings consistent with TB disease (e.g., caseating granuloma), signs or symptoms consistent with TB disease, sputum or tissue smear positive for AFB, a positive nucleic acid amplification test performed on the initial respiratory specimen, or a culture positive for M. tuberculosis. Prompt treatment should be initiated in consultation with a specialist for presumptive or confirmed clinical TB disease. All presumptive or confirmed cases (pulmonary or extrapulmonary) should be reported to the local health authorities within 24 hours of determination so that appropriate public health measures can be implemented, and management with an infectious disease or TB expert is recommended. Culture confirmation is not needed before starting therapy for cases with a high index of suspicion. When pulmonary or laryngeal TB is suspected, the patient should be isolated in an appropriate setting to prevent spread of infection until the patient is no longer considered infectious.

A complete discussion of treatment for TB disease and LTBI is beyond this scope of this guidance document. CDC treatment guidelines call for clinicians to not only prescribe an appropriate regimen (length of course of treatment and treatment regimen), but also ensure adherence to the regimen until treatment is completed. TB disease should be diagnosed and treated in consultation with the public health department and TB medical experts.

Treatment Guidelines

• Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020
• Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis

Sources of Additional Information

Additional information regarding tuberculosis can be found on the CDC TB website .

• Centers for Disease Control and Prevention (CDC), Reported Tuberculosis in the United States, 2019 . 2020, US Department of Health and Human Services, CDC: Atlanta, GA.
• Oeltmann, J.E., et al., Multidrug-resistant tuberculosis outbreak among US-bound Hmong refugees, Thailand, 2005. Emerg Infect Dis, 2008. 14 (11): p. 1715-21.
• Guo, H. and J. Wu, Persistent high incidence of tuberculosis among immigrants in a low-incidence country: impact of immigrants with early or late latency. Math Biosci Eng, 2011. 8 (3): p. 695-709.
• Tsang, C.A., et al., Tuberculosis Among Foreign-Born Persons Diagnosed >/=10 Years After Arrival in the United States, 2010-2015. MMWR Morb Mortal Wkly Rep, 2017. 66 (11): p. 295-298.
• Lillebaek, T., et al., Persistent high incidence of tuberculosis in immigrants in a low-incidence country. Emerg Infect Dis, 2002. 8 (7): p. 679-84.
• Bibbins-Domingo, K., et al., Screening for Latent Tuberculosis Infection in Adults: US Preventive Services Task Force Recommendation Statement. Jama, 2016. 316 (9): p. 962-9.
• Centers for Disease Control and Prevention. Deciding When to Treat Latent TB Infection . 2018 [cited 2020 October 21]; Available from: https://www.cdc.gov/tb/topic/treatment/decideltbi.htm .
• Sterling, T.R., et al., Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. MMWR Recomm Rep, 2020. 69 (1): p. 1-11.

• Immigrant and Refugee Health
• Travelers' Health
• Animal Importation
• Southern Border Health and Migration
• Port Health
• Division of Global Migration Health

Exit Notification / Disclaimer Policy

• The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
• Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
• You will be subject to the destination website's privacy policy when you follow the link.
• CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website.

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Privacy Policy

Naviera Dorada S.A. de C.V. hereinafter referred as “Sunset Admiral Yacht Club Y Marina”, with address in Boulevard Kukulcán Kilómetro 5.8 MZ-37 LT-18 SECC-C, Zona Hotelera, CP 77500, Cancún, Quintana Roo, Mexico, is responsible for the collection and use of the personal data required from customers, in terms of the rules established by the Mexican Federal Law for Data Protection of Private Individuals (Ley Federal de Protección de Datos Personales en Posesión de los Particulares – LFPDPPP ) as well in the rules established by articles 1, 3 and 5 of the General Data Protection Regulation (EU) 2016/679 (GDPR).

II. Data collected and use of the information requested from our customers.

In accordance with the rules established by LFPDPP and GDPR, we inform you that the personal data collected through our formats, by telephone or by electronic means (online) through our website, such as: name, phone number, email, home city, country, the national identity document, passport or the national voting card issued by National Electoral Institute (INE), will be used for the following essential purposes:

a) General Data

i. Provide and administrate the services contracted by our customers (rent of yachts, fishing boats and water scooters); ii. To lease stay spaces for vessels. iii. Register their information in our systems and databases; iv. To comply with the different laws that regulate our services and activities; v. To confirm, verify, correct and update their personal data; vi. To hire the insurance policies required by law; vii. To administrate the reservations requested by our customers; viii. To charge for our services and for the collection efforts with respect to receivables that are not paid when due; ix. To charge for services and programs paid electronically with a credit card; x. To charge any additional expenses or fees for extra services contracted, and;

Additionally, this information can be used for the following non-essential purposes:

a) To send customers: offers, discounts, special fees and other benefits; b) For statistical purposes; and, c) For promotional and marketing purposes.

b) Financial and Patrimonial Assets Data

The financial and patrimonial data collected such as insurance policy and vessel invoice, will be used to sign the lease contract of stay spaces for vessels. According to Mexican Privacy Law, is required to obtain express consent of customers in order to use and process their financial and patrimonial assets data for the different purposes and uses described above. Therefore in compliance with the law, we will request your express authorization in written at the moment of the data collection, informing you the legal consequences of their decision to grant it or not.

III. Data transfer.

The personal data collected by “Sunset Admiral Yacht Club Y Marina” can be transferred to companies that help provide some of the goods and services requested by our customers, which is necessary to comply with the provision of services that are contracted, so this information will be send to these providers in compliance with the provisions stated in article 37, section VII of the LFPDPPP, as well as the provision contained in article 49 of the GDPR.

Except for the cases indicated above, and unless the conditions set by articles 37 of the LFPDPPP and 49 of the GDPR are being materialized, the data provided by our customers will not be transferred under any circumstances.

IV. Restrictions on the use or disclosure of personal data

In Accordance to the articles 16 section III of the LFPDPPP and article 18 of the GDPR , those who wish to limit the use and disclosure of their personal data, or who no longer wish to receive communications regarding the non-essential purposes detailed in this privacy notice, must send an email to the adress: [email protected] requesting stop being contacted for these purposes.

V. Withdrawal of consent and rights of Access, Rectification, Cancellation and Opposition.

As stated in the LFPDPPP as of January 6, 2012, as well as in Articles 15, 16, 17, 18 of the GDPR, the owners of personal data collected by “Sunset Admiral Yacht Club Y Marina” may request: access, correction, cancellation (should this be legally appropriate) and opposition of the use of their personal data, as well as to withdraw their consent. To exercise these rights, they must follow this procedure:

1) They must send an application by email to our Privacy Office at [email protected] stating the right they want to exercise: access, correction, cancellation and/or opposition, which must indicate their full name, the legal or commercial relationship with “Sunset Admiral Yacht Club Y Marina” the type of right they wish to exercise, accurately identifying the data for which they request access, correction, cancellation or opposition, or those for which they decide to withdraw their consent, attaching any of the official identification documents (valid passport or current immigration document), in order to prove their identity

2) In the case of personal data whose owners are underage or people that cannot legally give consent themselves, this request must be made by the person who legally represents their rights, either through the accreditation of parental rights; or through his/her legally appointed guardian or tutor.

3) Data owners must send their application for the exercise of the aforementioned rights and may attach all the documents that are relevant to their request. For correction applications, it will be necessary to precisely specify the changes requested, including the documentation that supports their claim.

4) Applications for the exercise of these rights must be submitted during working hours and on business days in accordance with the Federal Law of Administrative Procedure.

5) The request must be sent to the email address mentioned in numeral 1) and an acknowledgment of receipt will be sent with the corresponding date of receipt. Should the application not fulfill the legal requirements, we will contact the holder within five (5) business days to ask to amend the application for up to ten (10) business days. Otherwise, the application will be considered as not submitted.

6) In the event that the request has been sent on Friday or on a non-business day, it may be received on the following business day after it was sent.

7) The request will be answered via email within a period of twenty (20) business days from the date of receipt. This period may be extended for twenty (20) additional business days when there are adequate reasons, and this situation will be notified to the holder under the terms of the provisions of Article 97 of the LFPDPPP Regulations.

8) In the event that the request is made in accordance with the LFPDPPP and other current regulations, access will be granted, the data will be corrected or canceled, the right of opposition will be effective or the consent will be revoked, within fifteen (15) business days following the date on which the request was answered. This period may be extended for fifteen (15) additional days for adequate reasons, and this situation will be notified to the holder under the terms of the provisions of Article 97 of the LFPDPPP Regulations. 9) In all cases where the request is appropriate, in accordance with the terms of Articles 32, 33, 34 and 35 of the LFPDPPP, the data will be sent free of charge through the holder’s email address for said purpose. In case the information should be required to be sent through another form of delivery, payment must be made for the cost of shipping and/or the cost of reproduction of copies or other formats that may be incurred.

9) In all cases where the request is appropriate, in accordance with the terms of Articles 32, 33, 34 and 35 of the LFPDPPP, the data will be sent free of charge through the holder’s email address for said purpose. In case the information should be required to be sent through another form of delivery, payment must be made for the cost of shipping and/or the cost of reproduction of copies or other formats that may be incurred.

VI. Online data management

This section describes the use of your personal data in the following website: https://tbtravel.club/experiences/sunset-admiral/

Online Privacy Policy

Our policy regarding the information related to the use of our website is described below. You should review this Privacy Policy regularly because it may change at any time at our discretion.

When you access to “Sunset Admiral Yacht Club Y Marina” website, we register your IP address (which is usually temporary and is assigned by your internet service provider when you log in), as well as the type of operating system and browser you use. In addition, we can trace the pages of the site you are visiting. The information we collect is used to improve our website’s user experience, and the whole process takes place without any knowledge of your name or any other information that will allow us to identify you. While visiting “Sunset Admiral Yacht Club Y Marina” website, your navigation is anonymous unless you decide to identify yourself to us.

“Sunset Admiral Yacht Club Y Marina” does not require that you provide personal data to use our website, unless it is necessary. Some applications may require you to disclose any personal information, our contact forms may require your email address to register and answer your comments, requests, questions or suggestions, and contact you if necessary. On these forms, we will not require your name, financial or property data, and/or sensitive data. Any disclosure of this information is your responsibility. Regardless of the above, if you voluntarily provide any of this information, “Sunset Admiral Yacht Club Y Marina” assures it will be used with strict confidentiality.

A cookie is information that an internet portal sends to your computer and is stored on your hard drive. The next time you visit our site, we may use the information stored in the cookie to facilitate the use of our websites. A cookie does not allow us to know your personal identity unless you explicitly choose to provide it. Most cookies expire after a short period of time or can be deleted by you at any time. Also, you can configure your browser to notify you when you receive a cookie so you can accept or reject it.

Social Networks

The personal data and information posted by the users of our social media is published on their own account and is subject to the terms and conditions established by the social media provider. “Sunset Admiral Yacht Club Y Marina” will use this information to answer the requests and questions asked by the users and to contact them in case they request it.

The contact data of the users who request information about travel packages, tours and other services will be shared with our Customer Service Center to give them a personalized attention by email or phone. The information provided by those users who decide to participate in our contests will be used to contact them in case they win, and their image may be published.

Data Portability

In Accordance with article 20 of the GDPR, you have the right to transfer your personal data to another supplier or controller without hindrance from the controller to which the personal data has been provided as long as the legal processing of your data has been carried out by automated means. “Sunset Admiral Yacht Club Y Marina”, ensures the strictest confidentiality and security to carry out the data transfer.

VII. Complaints regarding the use of your personal data.

If you believe that your rights regarding the protection of your personal data have been violated by any conduct, act or omission regarding the attention of your requests or in the use of your personal data, you can submit a complaint with the National Institute for Access to Information and Data Protection (INAI). For more information you can visit the website: www.inai.org.mx .

VIII. More Information – Privacy Office.

If you have any questions regarding the content, interpretation or scope of this Privacy Notice, if you need more information regarding the use of your personal data, please contact us through our Privacy Officer at the following email address: [email protected]

This Privacy Notice is effective from January 1st of 2012 and may be modified on a discretionary basis by “Sunset Admiral Yacht Club Y Marina”, under the terms of the LFPDPPP and its regulations, if you have any questions regarding to the content, interpretation or scope of this Privacy Notice, or you need more information regarding the use of your personal data, please contact our Privacy Office.

Last Updated: October 1st, 2020

Please contact us beforehand to receive important information.

If you reserved through a travel agency or directly with us call:

USA & CAN 1 800 494 9173 MÉX 01 800 890 7270 REST OF THE WORLD +52 (998) 881 4602

If you are a Member call

USA & CAN 1 (866) 760 1842, 1 (800) 896 1243,1 (800) 961 5089 MÉX 01 (800) 262 9648 COL 01 (800) 913 4927 REST OF THE WORLD +52 (998) 881 8750

If you reserved through RCI call: 01 800 681 6958

Reservations Cancún : Alberto Morales ext. 6462 Reservations Riviera Maya : Guillermo Rosales ext. 6184 Iliana Montembruck ext. 6145

Políticas de Privacidad

I. Responsible for the protection of your personal data. Hotelera Malecón S.A. de C.V. hereinafter Royal Sunset with address in Boulevard Kukulcán, kilometer 10 Apple 51, Lote 13-B Zona Hotelera, Zip Code 77500, Cancún Quintana Roo México, is responsible for the collection and use of the personal data required from the customers, visitors and vacational member club, in terms of the rules established by the Mexican Federal Law for Data Protection of Private Individuals (Ley Federal de Protección de Datos Personales en Posesión de los Particulares LFPDPPP) as well in the provisions of the articles 1º, 3º and 5º of the General Data Protection Regulation (EU) 2016/679 (GDPR) .

The personal data and documents collected from our customers at the resort, in our Website, online services or by phone, will be used to start, management and maintenance of ours services and to send discounts, offers and promotions in terms of what is stated in this section.

The general data requested in our forms such as: name, gender, signature, home address, phone number, cell phone number, e-mail, date of birth, job, home city, economic dependents, country, national identity document or passport will be used for the following essential purposes:

i. Provide all our services; ii. Include the information of our customers in our systems and databases to provide and administrate the services contracted; iii. Carry out the check-In and Check-out; iv. To comply with the different laws that regulate our services and activities; v. To attend complains, doubts and provide information to our customers, related to transportation, reservations or cancellations received by our Call Center; vi. To confirm, verify, correct and update your personal data; vii. For the administration of the services all inclusive, European plan and day pass viii. For the charge of our services and the collection efforts with respect to receivables that are not paid when due; ix. In order to do the charges on-line of the services and programs paid with credit card; x. To charge any extra charges or additional fees for extra services contracted by our customers and, xi. For the proper identification of our guests and customers.

a) To send our customers offers, discounts, special fees and other benefits; b) Spa Service c) Babysitting service d) To carry out wedding, banquets, and Honeymoon Service e) Gym Service f) Restaurant and Bar service g) Medical attention h) Transportation services i) Currency exchange j) For statistical purposes; and, k) For promotional and marketing purposes

The financial and patrimonial data collected such as credit card number, bank account, monthly income and additional incomes, will be used to purchase our wedding services and events, to purchase our vacation packages, to make reservations, to administrate our European plan analyze the financial profile of our guests and customers in order to grant them access to promotions and programs based on their economic characteristics. Furthermore, additional financial data and information related to the patrimonial assets of the clients may be required in compliance of Mexican Federal Law to prevent money laundering (Ley Federal para la Prevención e Identificación de Operaciones con Recursos de Procedencia Ilícita LFPIORPI).

According to Mexican Privacy Law, is required to obtain express consent of guests and customers in order to use and process their financial and patrimonial assets data for the different purposes and uses described above. Therefore, in compliance with the law, we will request your express authorization in written at the moment of the data collection.

c) Sensitive Data

The sensitive data collected such as health condition (allergies, disease, asthma, injuries, any illness) in our health questionnaire, babysitting service and medical care, will be used to value your health condition in order to purchase and carry out our services such as spa services, babysitting services and medical care.

According to the LFPDPPP article 9º and the provisions contained in article 9 (2.a) of the GDPR is required to obtain express consent of guests and customers in order to use and process their sensitive data for the different purposes and uses described above. Therefore, in compliance with the laws, we will request your express authorization in written at the moment of the data collection.

The personal data collected by Royal Sunset can be transfer to companies that help to provide some of the services requested by our customers. These data transfer is necessary to comply with the contract and therefore express consent is not necessary for these transferences.

Out of these cases and unless one of the provisions stated in article 37 of the LFPDPPP and in the provision contained in article 49 of the GDPR are met, the data provided by our guests, customers or vacation members club, will not be transferred under any circumstances to third parties.

IV. Use of images.

Events : In order to document and communicate information about the activities and events held throughout the year in the resort, as well as news Royal Sunset can use, print, reproduce and publish the images of our guests, visitors, vacation members club and customers and their friends or family that attend our activities in print or electronic media, newsletters, publications, photographic memories, in all its forms and expressions, performances, editions, phonograms, video and emissions for the purposes indicated. These images will not be commercially exploited by Royal Sunset .

Secondary Purposes

The information that we collect from our guests, vacation members club, and customers may be used for advertising, marketing and/or market research, according to the relationship existing between them and Royal Sunset . When Royal Sunset pretends to use the images for these purposes, the company will request your express authorization in written before its use.

V. Restrictions on the use or disclosure of personal data.

In Accordance to the articles 16 section III of the LFPDPPP and article 18 of the GDPR , If our customers do not wish to receive communications or advertising by Royal Sunset at any time they can: Subscribe their data in the “do not call list” (REPEP for its acronym in Spanish), administrated by the Bureau of Consumer Protection (PROFECO). For more information visit http://rpc.profeco.gob.mx/ ; or, send an email to the address [email protected] requesting stop being contacted for these purposes.

VI. Rights of access, rectification, cancellation and opposition, and withdrawal of consent.

As stated in the Federal Personal Data Protection Law and in the General Data Protection Regulation, customers may request the access, rectification, cancellation, oppose to the use of their personal data provided to the responsible, or revoke their consent. Their request will be answered by our Privacy Officer, through this email address: [email protected] To exercise these rights of access, rectification, cancellation, opposition, and to revoke the consent, the following procedure must be followed: 1) Send an email to the address [email protected] with your full name, your legal or commercial relationship with Royal Sunset , (for example guest or customer), and if you want to exercise your right of access, rectification, cancellation, opposition or revoke your consent. 2) Fill the application form that our Privacy Officer will send you, identifying the data on which you request the access, rectification, cancellation, opposition or the revoke of your consent, providing a copy of any of the identifications mentioned in the form in order to prove that you are the owner of the data or its legal representative. 3) After filling this form you must sent it to the e-mail address indicated in the previous paragraph, attaching all the documents that are relevant to answer your request. For “rectification” applications it will be necessary to specify the changes to be done, including the documentation that supports your request. 4) Once your request is received we will send you a notice with the file number and date of receipt. If your applicarion does not fulfill the legal requirements we will contact you within five business days of the receipt date informing you this situation. You will have ten business day to provide the information or documents required, otherwise your application will be considered as not submitted. 5) If your application was sent on a saturday, sunday or non-working day, it will be received the following working day. 6) Your request will be answered via e-mail in a period of twenty working days from the date of receipt. This period may be extended for twenty additional days for proper reasons, this situation will be notified to you in terms of the provisions of Article 97 of the LFPDPPP Regulations. 7) If your application is accepted we will give you access, rectify or cancel you data, register your opposition to the use of your information or revoke your consent within the fifteen business days from the date on which we answer your request. 8) This period may be extended for fifteen additional days for proper reasons, this situation will be notified to you in terms of the provisions of Article 97 of the LFPDPPP Regulations. 9) When your application is accepted, in terms of Articles 32, 33, 34 and 35 of the LFPDPPP we will sent your data without any charge through your email address, in case you request or need another form of delivery you will have to pay for the cost of shipment and/or the cost of reproduction of copies or other formats.

VII. Online data management.

This section describes the use of your personal data in the following website: – https://tbtravel.club/resorts/sunset-royal-beach-resort/

Our policy regarding the information related to the use of our website is described below. You should review this Privacy Policy regularly since it may change at any time at our discretion. When you access the website of Royal Sunset , we register your Internet address (this address usually is temporary and is assigned by your Internet service provider when you log in), the type of operating system and browser you use. In addition, we can trace the pages of the site that you are visiting. The information we collect is used to improve the users experience of our website, the whole process is done without any knowledge of your name or any other information that will allow us to identify you. While visiting the website of Royal Sunset , unless you decide to identify with us, your navigation is anonymous.

Royal Sunset , does not require that you provide personal data to use our website, unless necessary. Some applications may require you to disclose any personal information, our contact forms may require your email address to register and answer your comments, requests, questions or suggestions, and contact you if necessary. In these forms we will not require your name, financial, patrimonial and/or sensitive data, any disclosure of this information is your responsibility, regardless the above, if you voluntarily provide any of this information Royal Sunset assures it will be used with strict confidentiality.

Cookies : A cookie is information that an Internet portal sends to your computer, which is stored on your hard drive. The next time you visit our site, we may use the information stored in the cookie to facilitate the use of our website. A cookie does not allow us to know your personal identity unless you explicitly choose to provide it. Most cookies expire after a period of time or can be deleted by you at any time. Also you can configure your browser to notify you when you receive a cookie so you can accept or reject it.

Our website uses cookies to provide a personalized and secure experience to our users as well as to show users advertising related to their preferences. Cookies allow us to understand the behavior of our users on the site and improve it. If you decide to navigate our website, we understand that you consent to the processing of your personal data in accordance with “our online privacy policy” described in our Privacy Notice.

The data and information posted by the users of our social network, is published on their own account and is subjected to the terms and conditions established by the social network provider. Royal Sunset will use this information to answer the requests and questions asked by the users and to contact them in case they request so.

The contact data of the users that request information about travel packages, tours and other services will be shared with our Customer Service Center to give them a personalized attention by e-mail or phone. The information provided by those users who decide to participate in our contests will be use to contact them in case they win and their image may be published.

In Accordance with the article 20 of the GDPR , you have the right to transfer your personal data to another supplier or controller without hindrance from the controller to which the personal data have been provided as long as the legal processing oy your data has been carried out by automated means. Royal Sunset ensures the most strict confidentiality and security to carry out the data transfer.

VIII. Complaints regarding the use of your personal data

If you believe that your rights regarding the protection of your personal data have been violated by any conduct, act or omission regarding the attention of your requests or in the use of your personal data, you can submit a complaint with the National Institute for Access to Information and Data Protection (INAI) , for more information visit www.inai.org.mx

IX. More Information – Privacy Office.

If you have any questions regarding the content, interpretation or scope of this Privacy Notice, or need more information regarding the use of your personal data, please contact us through our Privacy Officer , at the following email address: [email protected] donde será atendido.

X. Updates.

This Privacy Notice is effective from January 1º of 2012 and may be modified on a discretionary basis by Royal Sunset , in terms of the GDPR and LFPDPPP and its regulations, any amendment will be communicated by posting the new Privacy Notice in of our website listed in the VII section of this Privacy Note, and in the Resort Lobby.

Last Update: December 1, 2018.

To Become a Sunset World Member, Request a Resort Preview

If you would like more information on Sunset World Resorts & Vacation Experiences Ownership, or if you would like us to contact you about a resort preview at one of our timeshare resort properties, please call us at 1 800 658 3141, write to us at [email protected] or fill out the form below.

Contact Information

I expressly consent and request that Sunset World Resorts & Vacation Experiences and its related and affiliated entities contact me at the number listed above using an automated telephone dialing system, prerecorded message, electronic mail or SMS text message, regardless of any prior election to the contrary. I acknowledge and agree that I am not required to sign this agreement as condition of purchasing any property, goods or services.

Preferred Date of Travel

I. Responsible for the protection of your personal data.

Promotora Sunset Beach Club S.A. de C.V. hereinafter referred as Promotora Sunset , with address in Boulevard Kukulcán, kilometer 10 Apple 51, Lote 13-B Zona Hotelera, Zip Code 77500, Cancún Quintana Roo México, is responsible for the collection and use of the personal data required from the vacational member club, in terms of the rules established by the Mexican Federal Law for Data Protection of Private Individuals (Ley Federal de Protección de Datos Personales en Posesión de los Particulares LFPDPPP) as well in the provisions of the articles 1º, 3º and 5º of the General Data Protection Regulation (EU) 2016/679 (GDPR) .

Personal data collected through physical formats in hotels, by telephone, or by electronic means (online) through our websites, will be used to begin, administer and maintain the services offered to our vacational members club.

• Begin providing services that customers contract with the company;
• To upload our vacational member club ´s information into our systems and database to provide and administer the services contracted
• To create our vacational member clubs ´electronic and paper files;
• Carry out the verification of your personal data collected by our Call Center;
• To comply with the different laws that regulate our services and activities;
• To deal with complaints and inquiries, and to provide our customers with information related to travel reservations or cancellations received by our Call Center;
• To confirm, verify, correct and update the personal data;
• Carry out the sign of the contract;
• To administrate your personal data in the sales room and contracting Area;
• To charge for our services and for the collection efforts with respect to receivables that are not paid when due;
• To charge for services and programs paid electronically with a credit card;
• To charge any additional expenses or fees for extra services contracted, and;
• To properly identify our clients as vacational members club or guests.
• a) To send our vacational member club offers, discounts, special fees and other benefits;
• b) To improve our holiday offer by sending your information to our business partners;
• c) For statistical purposes; and,
• d) For promotional and marketing purposes.

The financial and patrimonial data collected such as credit card number, bank account, monthly income and additional incomes, will be used to analyze the financial profile of our vacational members club and customers in order to grant them access to promotions and programs based on their economic characteristics. Furthermore additional information may be required in compliance of Mexican Federal Law to prevent money laundering (Lay Federal para la Prevención e Identificación de Operacions con Recursos de Procedencia lícita LFPIORPI).

According to Mexican Privacy Law, is required to obtain express consent of guests and customers in order to use and process their financial and patrimonial assets data for the different purposes and uses described above. Therefore in compliance with the law, we will request your express authorization in written at the moment of the data collection, informing you the legal consequences of their decision to grant it or not.

The personal data collected by “ Promotora Sunset ” can be transferred to companies that help provide some of the goods and services requested by our customers, which is necessary to comply with the provision of services that are contracted, and also can be transferred to companies who elaborate profiles and consumer trends for our vacational members club, therefore it will not be necessary to have the express consent of the owner of the data for this transfer in accordance to Article 37, Section VII of the LFPDPPP, as well as the provision contained in Article 49 of the GDPR.

Except for the cases indicated above, and unless one of the assumptions contained in Article 37 of the LFPDPPP and 49 of the GDPR is updated, the data provided by our visitors, partners, guests, vacational members club and referred visitors will not be transferred under any circumstances.

Moreover, “ Promotora Sunset ” may use, print, reproduce and publish any captured image(s) of partners vacational members club, guests, beneficiaries and people referred in print, electronic media (blogs, private social networks such as Facebook, website) , in all its manifestations, its interpretations or executions, its editions, its phonograms or videograms, and in its broadcasts, in order to document journalistically and communicate information related to events that are celebrated, such as delivery of awards and rewards, be the images captured by “ Promotora Sunset ” itself or through external suppliers hired for these activities.

When any image of any guest, partners, family member, client, partner or referral is going to be used for advertising purposes, this situation will be notified to the owners, and their express consent will be required in a specific format, to indicate whether they accept the treatment of the images for these purposes.

The information that we collect from our guests, members and customers may be used for advertising, marketing and/or market research, according to the relationship existing between them and “ Promotora Sunset ”. When “ Promotora Sunset ” pretends to use the images for these purposes, the company will request your express authorization in written before its use.

In Accordance to the articles 16 section III of the LFPDPPP and article 18 of the GDPR , those who wish to limit the use and disclosure of their personal data, or who no longer wish to receive communications regarding the non-essential purposes detailed in this privacy notice, may at any time sign up for the “do not call list” (known by its Spanish acronym REPEP), which is administered by the Bureau of Consumer Protection (PROFECO). For more information visit http://rpc.profeco.gob.mx/ ; or, send an email to the address [email protected] requesting stop being contacted for these purposes.

As stated in the LFPDPPP as of January 6, 2012, as well as in Articles 15, 16, 17, 18 of the GDPR, the holders of personal data collected by “ Promotora Sunset ” may request to access, correct, cancel (should this be legally appropriate) and oppose the use of their personal data, as well as to withdraw their consent. To exercise these rights, you must follow this procedure:

1) Send an email to our Privacy Officer at [email protected] to request the application document for the exercise of rights to access, correct, cancel and oppose, which must be filled out with your full name, your legal or commercial relationship with “ Promotora Sunset ” the type of right you wish to exercise, accurately identifying the data for which you request to access, correct, cancel or oppose, or those for which you decide to withdraw your consent, attaching any of the official identification documents (valid passport or current immigration document), in order to prove the identity with which the request is made.

2) In the case of personal data whose holders are minors or incapable persons, this request must be made by the person who legally represents the rights of the minor or incapable person, either through the accreditation of parental rights; or through his/her legally appointed guardian or tutor.

3) Holders must complete the application for the exercise of the aforementioned rights and may attach all the documents that are relevant to their request. For correction applications, it will be necessary to precisely specify the changes to be created, including the documentation that supports the origin of the request.

8) In the event that the request is made in accordance with the LFPDPPP and other current regulations, access will be granted, the data will be corrected or canceled, the right of opposition will be effective or the consent will be revoked, within fifteen (15) business days following the date on which the request was answered. This period may be extended for fifteen (15) additional days for adequate reasons, and this situation will be notified to the holder under the terms of the provisions of Article 97 of the LFPDPPP Regulations.

This section describes the use of your personal data in the following websites: – tbtravel.club

Our policy regarding the information related to the use of our websites is described below. You should review this Privacy Policy regularly because it may change at any time at our discretion.

When you access “Promotora Sunset” website, we register your IP address (which is usually temporary and is assigned by your internet service provider when you log in), as well as the type of operating system and browser you use. In addition, we can trace the pages of the site you are visiting. The information we collect is used to improve our website’s user experience, and the whole process takes place without any knowledge of your name or any other information that will allow us to identify you. While visiting any “Yucatán Holidays” website, your navigation is anonymous unless you decide to identify yourself to us.

“Promotora Sunset” does not require that you provide personal data to use any of our websites, unless it is necessary. Some applications may require you to disclose any personal information, our contact forms may require your email address to register and answer your comments, requests, questions or suggestions, and contact you if necessary. On these forms, we will not require your name, financial or property data, and/or sensitive data. Any disclosure of this information is your responsibility. Regardless of the above, if you voluntarily provide any of this information, “Promotora Sunset” assures it will be used with strict confidentiality.

The data and information posted by the users of our social media is published on their own account and is subject to the terms and conditions established by the social media provider. “Promotora Sunset” will use this information to answer the requests and questions asked by the users and to contact them in case they request it.

In Accordance with the article 20 of the GDPR , you have the right to transfer your personal data to another supplier or controller without hindrance from the controller to which the personal data have been provided as long as the legal processing oy your data has been carried out by automated means. Promotora Sunset , ensures the most strict confidentiality and security to carry out the data transfer.

VIII. Complaints regarding the use of your personal data.

If you believe that your rights regarding the protection of your personal data have been violated by any conduct, act or omission regarding the attention of your requests or in the use of your personal data, you can submit a complaint with the National Institute for Access to Information and Data Protection (INAI) , for more information visit www.inai.org.mx .

If you have any questions regarding the content, interpretation or scope of this Privacy Notice, or need more information regarding the use of your personal data, please contact us through our Privacy Officer , at the following email address [email protected]

This Privacy Notice is effective from January 1st of 2012 and may be modified on a discretionary basis by “ Promotora Sunset ”, under the terms of the LFPDPPP and its regulations, any amendment will be communicated by posting the new Privacy Notice in any of our website listed in the VII section of this Privacy Note.

Last Updated: June 1st 2020

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• Section 9 - United States Military Deployments
• Section 9 - Study Abroad & Other International Student Travel

Long-Term Travelers & Expatriates

Cdc yellow book 2024.

Author(s): Lin Hwei Chen, Davidson Hamer

Accessing Care Abroad

Infectious diseases not prevented by vaccines, mental health, long-term travelers with open itineraries, screening long-term travelers & expatriates after return.

The risk for illness or injury increases with duration of travel, so travelers planning long-term (commonly considered ≥6 months) visits to low- or middle-income countries require special consideration regardless of whether they are expatriates with definite plans or adventurers with open itineraries. Points to discuss in the pretravel consultation include accessing routine and emergency care at the destination, vaccines, infectious diseases not prevented by vaccines, injury prevention, and cultural and mental health issues that long-term travelers might encounter.

Before departure, all long-term travelers should undergo complete medical and dental examinations. For expatriates, a mental health evaluation prior to travel could identify and help address underlying issues that often cause early repatriation. Travelers should anticipate that they will need care at some point during their stay and plan where they will obtain it and how they will pay for it.

People traveling for work or with an organization (e.g., a nongovernmental organization, Peace Corps, a university) might have a predetermined source for care; some might access advice from the international expatriate community. By contrast, other travelers should identify a health care source in advance (see Sec. 6, Ch. 2, Obtaining Health Care Abroad ). Long-term travelers also should determine whether they will need supplemental travel health insurance and evacuation insurance (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ).

In some countries, travelers are likely to encounter medications of poor quality that are substandard, falsified, counterfeit, or expired. Because the pills and packaging could be nearly indistinguishable from their legitimate counterparts, travelers should bring a sufficient supply of their routine medications (e.g., antihypertensive or antihyperlipidemic drugs) from the United States (see Sec. 6, Ch. 3, . . . perspectives: Avoiding Poorly Regulated Medicines & Medical Products During Travel ).

Controlled substances and certain over-the-counter and commonly prescribed medications are illegal to bring into some countries. The International Society of Travel Medicine Pharmacist Professional Group offers the Database on International Regulations on Importation of Medicines for Personal Use ( Table 9-02 ). The International Narcotic Control Board website includes guidelines provided by each country and is a good reference for travelers looking for information about whether they can legally import their medications to their destinations ( Table 9-02 ).

Options for obtaining sufficient medications include requesting an override from the insurance company to dispense the entire quantity of medication; paying out-of-pocket for the full amount of medication needed and then submitting to the insurance company for reimbursement; refilling prescriptions during trips home; or relying on visiting friends or family members to bring refilled medication supplies.

Table 9-02 Importing medications for personal use

Long-term travelers should be aware of any vaccine requirements for entry, employment, or schooling at their destination. Update routine vaccines, including influenza vaccine, before travelers depart, and consider disease risk in surrounding areas because long-term travelers are likely to travel locally. A short-term traveler to Seoul, for example, would not be considered at risk for Japanese encephalitis (JE), but expatriates living in Seoul might have opportunities to visit the Korean countryside or other areas in Asia where they could be exposed to the JE virus. Similarly, consider yellow fever vaccination even if the posting location is not in an endemic area, because the traveler might journey to endemic areas while living abroad.

Hepatitis A & Typhoid Fever

Given the cumulative risk for hepatitis A and typhoid fever infection among long-term travelers, vaccination against these two diseases is appropriate (see Sec. 5, Part 2, Ch. 7, Hepatitis A , and Sec. 5, Part 1, Ch. 24, Typhoid & Paratyphoid Fever ). Neither of the US Food and Drug Administration (FDA)–approved typhoid vaccines, however, effectively prevents infection in all recipients; the injectable (ViCPS) and the oral (Ty21a) vaccine are each estimated to protect ≈50%–80% of recipients from infection. Thus, travelers who receive these vaccines should still adhere to safe food and water precautions (see Sec. 2, Ch. 8, Food & Water Precautions ). Moreover, duration of protection afforded by each vaccine is limited; a repeat dose of ViCPS is recommended every 2 years for travelers at continued risk of infection. For Ty21a recipients, a booster is recommended every 5 years.

Hepatitis B

Travel-associated hepatitis B infections are rare, but the risk for travelers might be greater than for nontravelers, especially for long-term travelers and expatriates, so consider hepatitis B vaccine for this population (see Sec. 5, Part 2, Ch. 8, Hepatitis B ).

Japanese Encephalitis

Infection with JE virus is associated with longer stays in endemic areas. JE vaccine is recommended for travelers who plan longer stays or residence in endemic areas, travelers anticipating outdoor activities in endemic areas after dusk, and travelers who are uncertain of specific destinations or activities (see Sec. 5, Part 2, Ch. 13, Japanese Encephalitis ).

Meningococcal

Meningococcal disease is more likely in travelers with prolonged exposure to local populations in endemic or epidemic areas; consider quadrivalent conjugate vaccine for at-risk travelers (see Sec. 5, Part 1, Ch. 13, Meningococcal Disease )

Rabies preexposure prophylaxis is an important consideration for people spending prolonged time in endemic countries , especially in places where rabies immune globulin is not available, which is true of many low- and middle-income countries. Prioritize vaccination for children who will be living in high-risk areas (see Sec. 5, Part 2, Ch. 18, Rabies , and Sec. 5, Part 2, Ch. 19, . . . perspectives: Rabies Immunization ).

Yellow Fever

Yellow fever vaccination might be required by some countries or recommended for endemic areas (see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country , and Sec. 5, Part 2, Ch. 26, Yellow Fever ). For instance, numerous unvaccinated Chinese expatriates became ill with yellow fever while working in Angola during the outbreak there in 2016, illustrating the importance of yellow fever vaccination for people who will be living or working in endemic areas.

Dengue & Other Arboviral Diseases

Dengue seroconversion among long-term travelers from the Netherlands with median travel duration of 20 weeks found an attack rate of 6.5% or incidence rate of 13.9 per 1,000 person-months travel in endemic areas. Other mosquito-borne viral illnesses (e.g., chikungunya, Zika), also pose potential risk. Advise long-term travelers and expatriates to protect themselves from mosquito vectors (see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods ); most travelers are not candidates to receive dengue vaccine (for details, see Sec. 5, Part 2, Ch. 4, Dengue ). Section 5 also provides disease-specific information on chikungunya and Zika virus infections.

Hepatitis C & Hepatitis E

Transfusion is a potential source of hepatitis C virus infection in expatriates. Hepatitis E virus is spread by the fecal–oral route; the risk for infection is greatest in Asia, although it has been transmitted in many different tropical locations. Pregnant people are at greatest risk for fulminant disease from hepatitis E. For more information on these infections, see the relevant chapters in Section 5.

HIV & Sexually Transmitted Infections

Travelers and expatriates are at increased risk for HIV and sexually transmitted infections (STIs), and the consistency of condom use among expatriates is low (see Sec. 9, Ch. 12, Sex & Travel ). Educate long-term travelers about the risk for HIV and STIs at their destination, as well as preventive measures. Consider the potential for occupational exposure to HIV among health care workers, and during the pretravel consultation include discussions of postexposure prophylaxis with antiretroviral therapy and risk avoidance (see Sec. 5, Part 2, Ch. 11, Human Immunodeficiency Virus / HIV , and Sec. 9, Ch. 4, Health Care Workers, Including Public Health Researchers & Medical Laboratorians ).

For long-term travelers, emphasize the importance of adjuncts to prophylaxis (see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods )). Even when urged to adhere to personal protective measures and reassured that long-term prophylaxis is safe and effective, traveler adherence likely will decline over time. Consequently, the pretravel consultation for a long-term traveler to malaria-endemic areas should stress the severity of the disease, its signs and symptoms, and the need to seek care immediately if signs and symptoms develop. Travelers also can consider bringing a reliable supply of drugs to treat malaria (atovaquone-proguanil or artemether lumefantrine) if they are diagnosed with the disease (see Sec. 2, Ch. 5, Yellow Fever Vaccine & Malaria Prevention Information, by Country , and Sec. 5, Part 3, Ch. 16, Malaria ).

Risk Factors Contributing to Infection

Data suggest that malaria incidence increases, and use of preventive measures decreases, with increasing length of stay abroad. Among expatriate corporate employees in Ghana, adherence to malaria prophylaxis deteriorated with increasing duration of stay, and all employees who had been on the site for >1 year had abandoned prophylaxis. About half of the cohort only intermittently used insect repellent, and more than one-third never used repellent.

Even though most British expatriates from the UK Foreign and Commonwealth Office had good knowledge about malaria and its prevention strategies, they adhered to malaria prophylaxis <25% of the time; only 25% reported rigorous compliance, and 13% reported having contracted malaria. A recent GeoSentinel Global Surveillance Network analysis found that Plasmodium falciparum malaria was the most frequent diagnosis among ill returned expatriate workers, occurring in 6%, and was acquired most commonly in sub-Saharan Africa. Given the high risk for malaria among travelers in Africa, these data on long-term travelers and expatriates highlight worrisome risks and practices.

French service members deployed to the Central African Republic for 4 months in 2013 experienced malaria at a rate of 150 cases per 1,000 person-years. A survey found that prophylaxis compliance correlated positively with use of other prophylactic measures against malaria (e.g., insecticide-treated clothing, mosquito net use, taking prophylaxis at the same time every day), correct perception of malaria risk, favorable perception of prophylaxis effectiveness, and peer-to-peer reinforcement.

Chemoprophylaxis

A traveler residing in an area of continuous malaria transmission should continue to use malaria prophylaxis for the entire stay. Doxycycline has been well tolerated for long-term malaria prophylaxis in the military, and the Centers for Disease Control and Prevention (CDC) has no recommended limits on its duration of use for malaria prophylaxis. Peace Corps volunteers frequently use mefloquine during prolonged stays and have a discontinuation rate of 0.9%. Mefloquine might be appropriate for long-term prophylaxis in chloroquine-resistant areas because of its convenient weekly dosing, but concern has increased regarding its neuropsychiatric side-effect profile, especially because the FDA label indicates that neurologic side effects could persist.

Atovaquone-proguanil has shown good long-term tolerability in post-marketing surveillance, with a discontinuation rate of only 1% because of diarrhea; for long-term use, however, atovaquone-proguanil can be a more expensive option than other antimalarial drugs. Peace Corps volunteers prescribed atovaquone-proguanil adhered to prophylaxis better than did people given doxycycline and mefloquine. If extended (>5 years) use of chloroquine is planned, a baseline ophthalmic examination with biannual follow-up is recommended to screen for potential retinal toxicity.

Because of its convenient weekly dosing, the antimalarial drug tafenoquine appears to be a promising choice for long-term travelers; an association with vortex keratopathy might limit its use. Moreover, tafenoquine use should be avoided in people with documented glucose-6-phosphate-dehydrogenase (G6PD) deficiency, as well as in those who have not been tested for G6PD deficiency. It is also not recommended for use in people with a history of psychotic disorder. Pregnancy is a contraindication to tafenoquine use.

The possibility of pregnancy requires careful consideration for travelers to areas where malaria is endemic (see Sec. 5, Part 3, Ch. 16, Malaria , and Sec. 7, Ch. 1, Pregnant Travelers ). Malaria infection during pregnancy can result in severe complications to both mother and fetus. When pregnancy is anticipated, prophylaxis options might need to be adjusted; explore the possibility of pregnancy with all long-term travelers of childbearing age before departure.

For a person who is pregnant or who plans to become pregnant during long-term travel, mefloquine is considered safe in all trimesters. Data from published studies in pregnant people have shown no increase in the risk for teratogenic effects or adverse pregnancy outcomes after mefloquine prophylaxis during pregnancy. Chloroquine also has been used long-term without ill effects on pregnancy. If a person traveling long-term is taking atovaquone-proguanil, doxycycline, or primaquine, they should discontinue their medication and begin weekly mefloquine (or chloroquine in those areas where it remains efficacious) for at least 3–4 weeks to build up a therapeutic blood level of mefloquine before attempting to conceive.

During the pretravel consultation, advise people of the potential risks associated with becoming pregnant while taking antimalarial drugs. Doxycycline, for example, is associated with fetal toxicity in animal studies, and its use is contraindicated during pregnancy. Primaquine and tafenoquine can harm a G6PD-deficient fetus, so should not be used. The effect of atovaquone-proguanil on the fetus is unknown.

Other Parasitic Infections

Parasitic infections vary with location and include amebiasis, filariasis, giardiasis, cutaneous leishmaniasis, schistosomiasis, and strongyloidiasis; vectorborne infections (e.g., filariasis, cutaneous leishmaniasis) can be prevented by using insect bite precautions and protective clothing, and by avoiding locations where the vectors are prevalent (see Sec. 5, Part 3, Ch. 9, Lymphatic Filariasis , and Sec. 5, Part 3, Ch. 14, Cutaneous Leishmaniasis ). For travelers with appropriate (or potential) geographic exposure risks, consider the possibility of filariasis and cutaneous leishmaniasis.

Travelers can avoid schistosomiasis by not bathing, swimming, or wading in fresh water, guidance that can be difficult to communicate to long-term travelers who, for example, might be living in sub-Saharan Africa and looking forward to river rafting or vacationing at a lake. Travelers can prevent Strongyloides stercoralis and hookworm infections by not walking barefoot through soil or on sandy beaches. The risks for schistosomiasis and strongyloidiasis can increase with long-term travel; consider screening travelers on their return, and suggest that people with access to health care also seek screening during long-term expatriate assignments (for details, see Sec. 11, Ch. 3, . . . perspectives: Screening Asymptomatic Returned Travelers ). Although seropositivity appears to be generally low for many parasitic infections, seroconversion for Schistosoma spp. occurred in 6% of Dutch long-term travelers to endemic areas.

Avoiding unwashed or uncooked foods, including greens and vegetables, can help reduce a travelers’ chances of ingesting foodborne parasites (e.g., Ascaris ).

Travelers’ Diarrhea

Because diarrhea and gastrointestinal diseases occur commonly, educate long-term travelers about ways to manage gastrointestinal illnesses (see Sec. 2, Ch. 6, Travelers’ Diarrhea ), including rehydration, use of antimotility agents, empiric antimicrobial therapy, and knowing when to seek care.

Compared with short-term travelers, long-term travelers experience more chronic diarrhea and postinfectious irritable bowel syndrome, possibly because some become less adherent to food and water precautions over time. Advise travelers of the need to continue food and water precautions to reduce the risk for these conditions (see Sec. 2, Ch. 8, Food & Water Precautions ).

Tuberculosis

In destinations where the burden of tuberculosis (TB) is high, the risk of infection in travelers can rise to that of the local population, depending on their length of stay and closeness of contact with the local population. For long-term travelers, consider a baseline interferon-γ release assay or a tuberculin skin test before travel, and repeat the same test after travel. TB screening is particularly important for health care workers or people working in hospitals, prisons, or refugee camps (see Sec. 5, Part 1, Ch. 23, . . . perspectives: Testing Travelers for Mycobacterium tuberculosis Infection ).

Because injuries are the leading cause of preventable death in travelers, educate long-term travelers about safety. Stress the importance of road and vehicle safety, and emphasize that travelers should choose the safest vehicle options available (see Sec. 8, Ch. 5, Road & Traffic Safety ). Roads are often poorly constructed and maintained, traffic laws might not be enforced, vehicles might not have seatbelts or be kept in good condition, and local drivers might be reckless and minimally trained. See Sec. 4, Ch. 12, Injury & Trauma , for strategies to reduce the risk of traffic and other injuries.

Culture shock and the stress of long-term travel can trigger or exacerbate mental illness. Assess long-term travelers for a preexisting diagnosis of mental illness, depressed mood, recent major life stressors, and use of medications that can adversely affect mental health. Any of these conditions suggest a need for further screening.

Warn all long-term travelers against illicit drug use, and urge them to take care of their physical and mental health by exercising regularly and eating healthfully. Travelers should be able to recognize signs of anxiety and depression and have a plan for coping. Having photographs or other mementos of friends and family at hand, and staying in close contact with loved ones at home, can alleviate the stress of long-term travel (see Sec. 2, Ch. 12, Mental Health ).

Offering pretravel care to long-term travelers, especially travelers with no itinerary or who have only vague travel plans, presents unique challenges. These travelers benefit from broad immunization coverage for all potential exposures to vaccine-preventable diseases.

Because their plans are unclear, these travelers must understand that they might need to diagnose and treat themselves for common ailments, including musculoskeletal problems, upper respiratory tract infections, skin disorders, travelers’ diarrhea, urinary tract infections, and vaginitis. For travelers (e.g., backpackers) who might go in and out of malaria-endemic areas, a sensible approach is to provide a supply of atovaquone-proguanil with instructions on how to take it when they visit risk areas.

In addition to strategies to prevent health problems and injuries during their long sojourns, traveler education is imperative regarding health resources, signs and symptoms that require urgent medical evaluation, and medical evacuation.

After returning to their country of origin, long-term travelers (e.g., highly adventurous travelers, expatriate workers, Peace Corps volunteers) ideally should have a thorough medical interview to assess potential infectious exposures. A careful itinerary-specific history with detailed questioning about potential high-risk exposures including animal, food and water, and human contacts is the foundation of the posttravel evaluation.

Conduct a physical examination focused on specific signs and symptoms, and a selected array of tests. These tests include a complete blood count with differential, hepatic transaminases, stool ova and parasite examination, and serologic markers depending on types of exposure, but most importantly for schistosomiasis and strongyloidiasis. Serologic testing can detect subclinical infections and help identify instances where treatment would be advised (see Sec. 11, Ch. 3, . . . perspectives: Screening Asymptomatic Returned Travelers ). The posttravel evaluation also provides an opportunity for preventive counseling for potential future travel.

The following authors contributed to the previous version of this chapter: Lin H. Chen, Davidson H. Hamer

Bibliography

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Créach M-A, Velut G, de Laval F, Briolant S, Aigle L, Marimoutou C, et al. Factors associated with malaria chemoprophylaxis compliance among French service members deployed in Central African Republic. Malaria J. 2016;15:174.

Cunningham J, Horsley J, Patel D, Tunbridge A, Lalloo DG. Compliance with long-term malaria prophylaxis in British expatriates. Travel Med Infect Dis. 2014;12(4):341–8.

Hamer DH, Ruffing R, Callahan MV, Lyons SH, Abdullah AS. Knowledge and use of measures to reduce health risks by corporate expatriate employees in western Ghana. J Travel Med. 2008;15(4):237–42.

Landman KZ, Tan KR, Arguin PM; Centers for Disease Control and Prevention (CDC). Knowledge, attitudes, and practices regarding antimalarial chemoprophylaxis in U.S. Peace Corps Volunteers—Africa, 2013. MMWR Morb Mortal Wkly Rep. 2014;63(23):516–7.

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Soonawala D, van Lieshout L, den Boer MA, Claas EC, Verweij JJ, Godkewitsch A, Ratering M, et al. Post-travel screening of asymptomatic long-term travelers to the tropics for intestinal parasites using molecular diagnostics. Am J Trop Med Hyg. 2014;90(5):835–9.

Whelan J, Belderok S, van den Hoek A, Sonder G. Unprotected casual sex equally common with local and Western partners among long-term Dutch travelers to (sub)tropical countries. Sex Transm Dis. 2013;40(10):797–800.

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More From Forbes

Planning a vacation here’s your 2024 summer travel insurance guide.

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The joy of a summer vacation. But do you have protection for your trip?

Planning a vacation this summer? Yeah, you and just about everyone else.

More than 9 out of 10 Americans say they'll travel more this year, according to a recent Nationwide Travel Insurance survey . Most of those trips will happen in June, July and August.

Not just that, but 40 percent of the respondents say they'll spend more this year than last year. So how do you protect your vacation investment?

Travel insurance is the standard answer, but what kind of insurance — and how do you find it? That's the question many Americans are wrestling with as they make their travel plans.

Protecting your vacation is a serious concern this summer, experts say.

“Travelers are beefing up their trip protection with security advisory and extraction protection," notes Dan Richards, CEO of The Global Rescue Companies .

It's not just that they're spending more. It's that there's more to lose. The ongoing war in Ukraine, the Hamas attacks on Israel, and other violent conflicts have made travel insurance a key part of trip planning.

This summer may break travel records, experts say.

Samsung Issues Critical Update For Millions Of Galaxy Users

Ufc 300 results bonus winners after historic event, ufc 300 results winners and losers from pereira vs hill fight card, it's going to be a busy summer for travel.

Overall policy sales for the 2024 summer travel season are up this year, but there's a spike in sales for policies in August, which is typically the busiest time of the summer. "Sales are up more than 25% over last year," says Stan Sandberg, co-founder of travel insurance site TravelInsurance.com .

Western Europe continues to be the most popular summer destination for Americans, with some notable hotspots. Travel insurance sales for Greece are up over 60% this year compared with 2023, followed by Norway and Portugal, which are up 57% and 52%, respectively, according to Sandberg.

Everyone's travel insurance needs are different, according to the pros.

What should you insure when you travel this summer?

Laura Heidt, the insurance desk manager for Brownell Travel in Birmingham, Ala., says there are some things every travel insurance policy should cover this summer.

"I always recommend people insure for the unexpected, such as flight delays, missed connections and medical coverage while out of the country," she says. "If you are willing to forgo the cancellation and delay coverages, which are typically the most expensive parts of a policy, you should still, absolutely, cover yourself with at least the medical component."

Heidt says she's seen a 10% boost in travel insurance sales for this summer compared with the same time last year, and many people are opting for the pricier "cancel for any reason" policies, which allow you to cancel your trip and receive a partial refund of your prepaid, nonrefundable travel expenses.

Travel insurance companies are seeing a similar trend.

"A majority of travelers choose a comprehensive travel insurance plan which includes coverage for trip cancellation, emergency medical, lost or delayed baggage and delay," explains Tim Dodge, vice president of marketing at Arch RoamRight .

He says this year, travelers are purchasing travel insurance on average within 11 days of their trip deposit to receive the additional benefit of the waiver exclusion for pre-existing conditions.

If you're traveling with kids, you'll need extra travel insurance protection.

Get a policy that's tailored to your needs

Travel insurance comes in all shapes and sizes. So you'll want to try a few on for size before you buy. You can actually do that, since most policies have a "free look" period that makes them fully refundable for the first week or two (depending on the policy).

"It's important to consider your specific travel plans and any potential disruptions in order to protect your investment," says Robert Gallagher, president of the US Travel Insurance Association (USTIA).

He says traditional plans offer coverage for unexpected cancellations, interruptions, delays, emergency medical expenses and lost or delayed baggage. For international travel, USTIA advises opting for a plan with emergency medical and medical evacuation coverage.

It also depends on who you're traveling with. For example, if you're traveling with your children, you'll want to consider a family-friendly priced travel insurance plan. But your destination also matters, says Carol Mueller, vice president at Berkshire Hathaway Travel Protection (BHTP).

"For young families, I typically recommend the ExactCare plan due to its pricing of two children at no additional cost for every one adult on the policy," she says. "However, for families venturing abroad, I’d suggest considering a plan like BHTP's LuxuryCare, which is designed to meet the distinctive needs of a high-investment vacation.”

You have choices when it comes to family coverage. For example, Allianz’s OneTrip Prime plan also includes coverage for kids 17 and younger when traveling with a parent or grandparent.

Medical evacuations can be expensive.

Look beyond travel insurance for extra protection

Mike Hallman, CEO of the air medical transport and travel security program Medjet , says MedjetHorizon memberships are selling briskly. They offer 24/7 security and crisis response, as well as transportation to a hospital at home if you're injured. Travelers are skittish even if they aren't going bungee-jumping.

"With geopolitical tensions still growing — all the riots in France, Italy, Ecuador and other tourist destinations over the last year — and crime causing the threat level to be raised for the Bahamas and Jamaica, it’s no wonder," he adds.

He makes a good point. Travel insurance can cover many of the events you're likely to encounter, such as a missed connection, lost luggage or a medical emergency. But it's also important to know what isn't covered — and to make plans accordingly.

Beware of travel insurance "overconfidence"

The summer travel season is still a few months away, but insurance experts are worried. Yes, they've seen a general uptick in insurance sales, but some travelers remain unprotected.

"We've started to see early signs that travelers are exercising less caution and are slightly less likely to sign up for travel insurance," says Joe Cronin, CEO of International Citizens Insurance .

By comparison, travelers purchased plenty of medical insurance in 2020 and 2021 because of the pandemic. Cronin believes travelers were terrified of getting stuck with COVID-19 in a foreign country without insurance.

"To those who are thinking about traveling internationally without travel insurance, my recommendation is to spend a few minutes looking deeper before deciding," he adds.

Some types of insurance, such as a standalone medical policy, cost just a few dollars a day. A medical evacuation membership is also affordable. And even full-featured travel insurance policies can be cost-effective when you consider the benefits.

"Don’t put your summer travel memories, or your investment, at risk by forgoing the right vacation coverage," says Daniel Durazo, director of communications at Allianz Partners USA . "With international travel peaking during the summer season, an unprotected trip can leave travelers on the hook for costs resulting from an unexpected trip delay or medical emergency abroad."

Bottom line: Seriously consider travel insurance to protect your trip — and don't be overconfident. You never know what might happen this summer.

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